Provider Demographics
NPI:1497179725
Name:CENTER FOR COMPLETE DENTISTRY OF PEMBROKE PINES
Entity Type:Organization
Organization Name:CENTER FOR COMPLETE DENTISTRY OF PEMBROKE PINES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ARUN
Authorized Official - Middle Name:K
Authorized Official - Last Name:GARG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-392-1635
Mailing Address - Street 1:700 N HIATUS RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-5206
Mailing Address - Country:US
Mailing Address - Phone:954-392-1635
Mailing Address - Fax:954-392-1637
Practice Address - Street 1:700 N HIATUS RD
Practice Address - Street 2:SUITE 102
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-5206
Practice Address - Country:US
Practice Address - Phone:954-392-1635
Practice Address - Fax:954-392-1637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN11076305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization