Provider Demographics
NPI:1275041154
Name:601 DENTAL STUDIO PA
Entity Type:Organization
Organization Name:601 DENTAL STUDIO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NADJA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HORST
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-895-4398
Mailing Address - Street 1:601 N FLAMINGO RD STE 415
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1012
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 N FLAMINGO RD STE 415
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1012
Practice Address - Country:US
Practice Address - Phone:954-438-4444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-13
Last Update Date:2018-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN156761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty