Provider Demographics
NPI:1508897679
Name:APPEARANCE IMPLANT AND LASER DENTISTRY OF JUPITER
Entity Type:Organization
Organization Name:APPEARANCE IMPLANT AND LASER DENTISTRY OF JUPITER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WADE
Authorized Official - Middle Name:BYRON
Authorized Official - Last Name:HARROUFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:561-741-7142
Mailing Address - Street 1:267 RIVER DR
Mailing Address - Street 2:
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-1933
Mailing Address - Country:US
Mailing Address - Phone:561-745-7186
Mailing Address - Fax:561-743-8306
Practice Address - Street 1:6390 W INDIANTOWN RD STE 32
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7980
Practice Address - Country:US
Practice Address - Phone:561-741-7142
Practice Address - Fax:561-741-7914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN107611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN10761OtherDENTAL LICENSE