Provider Demographics
NPI:1326651712
Name:BOCA KIDS DENTISTRY INC
Entity Type:Organization
Organization Name:BOCA KIDS DENTISTRY INC
Other - Org Name:MINI MOUTHS DENTISTRY FOR KIDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGELNICK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-609-5681
Mailing Address - Street 1:5442 NW 80TH TER
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-1168
Mailing Address - Country:US
Mailing Address - Phone:954-609-5681
Mailing Address - Fax:
Practice Address - Street 1:20401 STATE RD. #7
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33498
Practice Address - Country:US
Practice Address - Phone:954-609-5681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-26
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty