Provider Demographics
NPI:1467737304
Name:DENTAL CENTER OF COUNTRY WALK, LLC
Entity Type:Organization
Organization Name:DENTAL CENTER OF COUNTRY WALK, LLC
Other - Org Name:DENTAL CENTER OF COUNTRY WALK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:LEKKAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-383-4973
Mailing Address - Street 1:15721 SW 152ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33187-5417
Mailing Address - Country:US
Mailing Address - Phone:305-233-3335
Mailing Address - Fax:305-233-3909
Practice Address - Street 1:15721 SW 152ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33187-5417
Practice Address - Country:US
Practice Address - Phone:305-233-3335
Practice Address - Fax:305-233-3909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-11
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty