Provider Demographics
NPI:1528369014
Name:SAWGRASS ORTHODONTICS, LLC
Entity Type:Organization
Organization Name:SAWGRASS ORTHODONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PENELOPE
Authorized Official - Middle Name:
Authorized Official - Last Name:REINGOWSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-514-2111
Mailing Address - Street 1:175 NW 136TH AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33325-2624
Mailing Address - Country:US
Mailing Address - Phone:954-514-2111
Mailing Address - Fax:
Practice Address - Street 1:175 NW 136TH AVE
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33325-2624
Practice Address - Country:US
Practice Address - Phone:954-514-2111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-15
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN169021223X0400X
FLDN167481223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty