Provider Demographics
NPI:1235300583
Name:DENTAL HEALTH GROUP, PC
Entity Type:Organization
Organization Name:DENTAL HEALTH GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-652-6313
Mailing Address - Street 1:20295 NW 2ND AVE
Mailing Address - Street 2:STE 210
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-2550
Mailing Address - Country:US
Mailing Address - Phone:306-652-6313
Mailing Address - Fax:
Practice Address - Street 1:1058 N TAMIAMI TRL
Practice Address - Street 2:STE 106
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-2416
Practice Address - Country:US
Practice Address - Phone:941-757-1114
Practice Address - Fax:941-757-1117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN102191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty