Provider Demographics
NPI:1164728200
Name:AESTHETIC DENTAL GROUP
Entity Type:Organization
Organization Name:AESTHETIC DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOIRAC
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-563-5535
Mailing Address - Street 1:2330 NE 9TH ST
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3579
Mailing Address - Country:US
Mailing Address - Phone:954-563-5535
Mailing Address - Fax:954-563-8888
Practice Address - Street 1:2330 NE 9TH ST
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3579
Practice Address - Country:US
Practice Address - Phone:954-563-5535
Practice Address - Fax:954-563-8888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN179311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1223G0001XOtherGENERAL PRACTICE ( DENTAL)