Provider Demographics
NPI:1467670919
Name:PLANTATION DENTAL ARTS ASSOCIATES, PA
Entity Type:Organization
Organization Name:PLANTATION DENTAL ARTS ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:COLETTI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-327-8075
Mailing Address - Street 1:300 NW 70TH AVE
Mailing Address - Street 2:SUITE #104
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2384
Mailing Address - Country:US
Mailing Address - Phone:954-327-8075
Mailing Address - Fax:
Practice Address - Street 1:300 NW 70TH AVE
Practice Address - Street 2:SUITE #104
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2384
Practice Address - Country:US
Practice Address - Phone:954-327-8075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14838261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental