Provider Demographics
NPI:1508084609
Name:DEERFIELD CENTER FOR DENTAL SPECIALTIES
Entity Type:Organization
Organization Name:DEERFIELD CENTER FOR DENTAL SPECIALTIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:PONCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-427-4287
Mailing Address - Street 1:1800 W HILLSBORO BLVD
Mailing Address - Street 2:#211
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-1484
Mailing Address - Country:US
Mailing Address - Phone:954-427-4287
Mailing Address - Fax:954-427-5540
Practice Address - Street 1:1800 W HILLSBORO BLVD
Practice Address - Street 2:#211
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-1484
Practice Address - Country:US
Practice Address - Phone:954-427-4287
Practice Address - Fax:954-427-5540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL084901223E0200X
FL151741223P0300X
FL135181223S0112X
FL145211223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
Not Answered1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty