Provider Demographics
NPI:1427190024
Name:FIRST DENTAL P.A.
Entity Type:Organization
Organization Name:FIRST DENTAL P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:PUSATERI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-776-4440
Mailing Address - Street 1:2500 E COMMERCIAL BLVD
Mailing Address - Street 2:SUITE G
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4124
Mailing Address - Country:US
Mailing Address - Phone:954-776-4440
Mailing Address - Fax:954-776-4740
Practice Address - Street 1:2500 E COMMERCIAL BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4124
Practice Address - Country:US
Practice Address - Phone:954-776-4440
Practice Address - Fax:954-776-4740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN174941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty