Provider Demographics
NPI:1184861981
Name:THE FAMILY DENTAL CARE CENTER
Entity Type:Organization
Organization Name:THE FAMILY DENTAL CARE CENTER
Other - Org Name:THE FAMILY DENTAL CARE CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-242-1200
Mailing Address - Street 1:646 W PALM DR
Mailing Address - Street 2:202
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33034-3208
Mailing Address - Country:US
Mailing Address - Phone:305-242-1200
Mailing Address - Fax:305-242-8782
Practice Address - Street 1:646 W PALM DR
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33034-3208
Practice Address - Country:US
Practice Address - Phone:305-242-1200
Practice Address - Fax:305-242-8782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL070376101Medicaid
FL0755532 00Medicaid