Provider Demographics
NPI:1497097091
Name:DENTAQUEST OF FLORIDA, INC.
Entity Type:Organization
Organization Name:DENTAQUEST OF FLORIDA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-886-1511
Mailing Address - Street 1:465 MEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02129-1426
Mailing Address - Country:US
Mailing Address - Phone:617-886-1818
Mailing Address - Fax:
Practice Address - Street 1:465 MEDFORD ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02129-1426
Practice Address - Country:US
Practice Address - Phone:617-886-1818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAQUEST, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty