Provider Demographics
NPI:1467583229
Name:PERIODONTICS OF THE PALM BEACHES, P.A.
Entity Type:Organization
Organization Name:PERIODONTICS OF THE PALM BEACHES, P.A.
Other - Org Name:FELDMAN AND LAZZARA, P.A.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER-PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:A
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:561-686-2477
Mailing Address - Street 1:1897 PALM BEACH LAKES BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-3507
Mailing Address - Country:US
Mailing Address - Phone:561-686-2477
Mailing Address - Fax:561-686-2699
Practice Address - Street 1:1897 PALM BEACH LAKES BLVD
Practice Address - Street 2:SUITE 215
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-3507
Practice Address - Country:US
Practice Address - Phone:561-686-2477
Practice Address - Fax:561-686-2699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL51911223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty