Provider Demographics
NPI:1235501420
Name:AESTHETIC DENTAL DESIGNS, PA
Entity Type:Organization
Organization Name:AESTHETIC DENTAL DESIGNS, PA
Other - Org Name:DENTAL ARTS OF ATLANTIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-965-6003
Mailing Address - Street 1:5057 S CONGRESS AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-4723
Mailing Address - Country:US
Mailing Address - Phone:561-965-6003
Mailing Address - Fax:561-965-8447
Practice Address - Street 1:5057 S CONGRESS AVE STE 401
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-4723
Practice Address - Country:US
Practice Address - Phone:561-965-6003
Practice Address - Fax:561-965-8447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-27
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty