Provider Demographics
NPI:1568227098
Name:BROWARD PERIODONTICS AND IMPLANT DENTISTRY PLLC
Entity Type:Organization
Organization Name:BROWARD PERIODONTICS AND IMPLANT DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-333-8211
Mailing Address - Street 1:7901 SW 6TH CT STE 100
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3248
Mailing Address - Country:US
Mailing Address - Phone:954-581-5922
Mailing Address - Fax:
Practice Address - Street 1:4350 SHERIDAN ST STE 201D
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3556
Practice Address - Country:US
Practice Address - Phone:954-981-0012
Practice Address - Fax:954-986-9966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty