Provider Demographics
NPI:1164668547
Name:MY DENTIST FOR LIFE, P.A.
Entity Type:Organization
Organization Name:MY DENTIST FOR LIFE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SABA
Authorized Official - Middle Name:MANZOOR
Authorized Official - Last Name:RIZVI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-432-3655
Mailing Address - Street 1:294 NW 172ND AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-3196
Mailing Address - Country:US
Mailing Address - Phone:954-432-3655
Mailing Address - Fax:954-438-0334
Practice Address - Street 1:294 NW 172ND AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-3196
Practice Address - Country:US
Practice Address - Phone:954-432-3655
Practice Address - Fax:954-438-0334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15321261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental