Provider Demographics
NPI:1235698556
Name:PEDIATRIC & GENERAL DENTISTRY OF PALM BEACH, PA
Entity Type:Organization
Organization Name:PEDIATRIC & GENERAL DENTISTRY OF PALM BEACH, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:LILIEM
Authorized Official - Middle Name:
Authorized Official - Last Name:SOCARRAS DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-508-5930
Mailing Address - Street 1:1620 S CONGRESS AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-2128
Mailing Address - Country:US
Mailing Address - Phone:561-777-0095
Mailing Address - Fax:
Practice Address - Street 1:1620 S CONGRESS AVE STE 102
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-2128
Practice Address - Country:US
Practice Address - Phone:617-770-0955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-16
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty