Provider Demographics
NPI:1437537727
Name:AMERICAN PEDIATRIC DENTAL GROUP CORAL SPRINGS
Entity Type:Organization
Organization Name:AMERICAN PEDIATRIC DENTAL GROUP CORAL SPRINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:STTEPHANIE
Authorized Official - Last Name:GRUBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-417-1337
Mailing Address - Street 1:3353 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071
Mailing Address - Country:US
Mailing Address - Phone:844-304-5437
Mailing Address - Fax:
Practice Address - Street 1:3353 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071
Practice Address - Country:US
Practice Address - Phone:844-304-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty