Provider Demographics
NPI:1477793933
Name:PALM BEACH PROSTHODONTICS, LLC
Entity Type:Organization
Organization Name:PALM BEACH PROSTHODONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE - PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SANTAMARINA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-682-0999
Mailing Address - Street 1:1401 FORUM WAY
Mailing Address - Street 2:SUITE 800
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401
Mailing Address - Country:US
Mailing Address - Phone:561-682-0999
Mailing Address - Fax:561-383-0899
Practice Address - Street 1:1401 FORUM WAY
Practice Address - Street 2:SUITE 800
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401
Practice Address - Country:US
Practice Address - Phone:561-682-0999
Practice Address - Fax:561-383-0899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1223G0001X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty