Provider Demographics
NPI:1417300435
Name:C NICK DETURE PA
Entity Type:Organization
Organization Name:C NICK DETURE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:DETURE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-427-5700
Mailing Address - Street 1:1500 E HILLSBORO BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-4356
Mailing Address - Country:US
Mailing Address - Phone:954-427-5700
Mailing Address - Fax:954-427-5990
Practice Address - Street 1:1500 E HILLSBORO BLVD STE 101
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-4356
Practice Address - Country:US
Practice Address - Phone:954-427-5700
Practice Address - Fax:954-427-5990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14431122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty