Provider Demographics
NPI:1275795825
Name:DENTALAND PA
Entity Type:Organization
Organization Name:DENTALAND PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:FEINGOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-719-4420
Mailing Address - Street 1:3230 W COMMERCIAL BLVD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3429
Mailing Address - Country:US
Mailing Address - Phone:954-719-4420
Mailing Address - Fax:954-678-9539
Practice Address - Street 1:2960 AVENTURA BLVD
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3103
Practice Address - Country:US
Practice Address - Phone:305-935-1400
Practice Address - Fax:305-932-6464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN5487122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty