Provider Demographics
NPI:1578333084
Name:PALM BEACH ORTHODONTIC SPECIALISTS
Entity Type:Organization
Organization Name:PALM BEACH ORTHODONTIC SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:917-817-7968
Mailing Address - Street 1:5205 CONGRESS AVE APT 739
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-3963
Mailing Address - Country:US
Mailing Address - Phone:917-817-7968
Mailing Address - Fax:
Practice Address - Street 1:8487 LAKE WORTH ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-3348
Practice Address - Country:US
Practice Address - Phone:917-817-7968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PALM BEACH ORTHODONTIC SPECIALISTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty