Provider Demographics
NPI:1417982844
Name:CHILDRENS DENTAL PLACE OF BOCA RATON INC
Entity Type:Organization
Organization Name:CHILDRENS DENTAL PLACE OF BOCA RATON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:HANDEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-470-1109
Mailing Address - Street 1:20401 STATE ROAD 7
Mailing Address - Street 2:SUITE G-14
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498
Mailing Address - Country:US
Mailing Address - Phone:561-470-1109
Mailing Address - Fax:561-470-9728
Practice Address - Street 1:20401 STATE ROAD 7
Practice Address - Street 2:SUITE G-14
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33498-6794
Practice Address - Country:US
Practice Address - Phone:561-470-1109
Practice Address - Fax:561-470-9728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty