Provider Demographics
NPI:1316225121
Name:FLORIDA INSTITUTE FOR PERIODONTICS & DENTAL IMPLANTS, P.A.
Entity Type:Organization
Organization Name:FLORIDA INSTITUTE FOR PERIODONTICS & DENTAL IMPLANTS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-655-1700
Mailing Address - Street 1:1515 N FLAGLER DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3428
Mailing Address - Country:US
Mailing Address - Phone:561-655-1700
Mailing Address - Fax:561-853-0793
Practice Address - Street 1:1300 CORPORATE CENTER WAY
Practice Address - Street 2:SUITE 204
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-8599
Practice Address - Country:US
Practice Address - Phone:561-792-7084
Practice Address - Fax:561-853-0793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty