Provider Demographics
NPI:1437536703
Name:DENTALWORKS STUDIO OF INDIANTOWN PA
Entity Type:Organization
Organization Name:DENTALWORKS STUDIO OF INDIANTOWN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-642-1177
Mailing Address - Street 1:6336 FOREST HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33415-6104
Mailing Address - Country:US
Mailing Address - Phone:561-642-1177
Mailing Address - Fax:561-642-1143
Practice Address - Street 1:15275 SW ADAMS AVE
Practice Address - Street 2:
Practice Address - City:INDIANTOWN
Practice Address - State:FL
Practice Address - Zip Code:34956-3433
Practice Address - Country:US
Practice Address - Phone:772-597-4627
Practice Address - Fax:772-597-4630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18835122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty