Provider Demographics
NPI:1326702036
Name:SYNERGY AESTHETIC DENTAL CORP
Entity Type:Organization
Organization Name:SYNERGY AESTHETIC DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOBADILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-894-2121
Mailing Address - Street 1:2301 N UNIVERSITY DR STE 209
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3617
Mailing Address - Country:US
Mailing Address - Phone:954-894-2121
Mailing Address - Fax:
Practice Address - Street 1:2301 N UNIVERSITY DR STE 209
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-3617
Practice Address - Country:US
Practice Address - Phone:954-894-2121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty