Provider Demographics
NPI:1417613092
Name:EAST BROWARD DENTAL
Entity Type:Organization
Organization Name:EAST BROWARD DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BURAK
Authorized Official - Middle Name:
Authorized Official - Last Name:TASKONAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-905-2000
Mailing Address - Street 1:1212 E BROWARD BLVD # 200
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2123
Mailing Address - Country:US
Mailing Address - Phone:954-905-2000
Mailing Address - Fax:954-905-1399
Practice Address - Street 1:1212 E BROWARD BLVD # 200
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2123
Practice Address - Country:US
Practice Address - Phone:954-905-2000
Practice Address - Fax:954-905-1399
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST BROWARD DENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty