Provider Demographics
NPI:1346674967
Name:DENTAL SPECIALISTS OF BROWARD GROUP
Entity Type:Organization
Organization Name:DENTAL SPECIALISTS OF BROWARD GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-588-4671
Mailing Address - Street 1:9 SW 17TH ST
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33315-1741
Mailing Address - Country:US
Mailing Address - Phone:954-588-4671
Mailing Address - Fax:305-593-6855
Practice Address - Street 1:9 SW 17TH ST
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33315-1741
Practice Address - Country:US
Practice Address - Phone:954-588-4671
Practice Address - Fax:305-593-6855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-30
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 20461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty