Provider Demographics
NPI:1235799131
Name:SANITAS DENTAL OF SOUTH FLORIDA, P.A.
Entity Type:Organization
Organization Name:SANITAS DENTAL OF SOUTH FLORIDA, P.A.
Other - Org Name:SANITAS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/PRACTICE OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:F
Authorized Official - Last Name:BRETON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-434-3229
Mailing Address - Street 1:5810 S FLAMINGO RD
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33330-3237
Mailing Address - Country:US
Mailing Address - Phone:954-434-3229
Mailing Address - Fax:954-680-6254
Practice Address - Street 1:5810 S FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33330-3237
Practice Address - Country:US
Practice Address - Phone:954-434-3229
Practice Address - Fax:954-680-6254
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANITAS DENTAL OF SOUTH FLORIDA, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1538396791OtherDOCTOR'S NPI