Provider Demographics
NPI:1609538388
Name:ADVANCED DENTISTRY OF CORAL SPRINGS
Entity Type:Organization
Organization Name:ADVANCED DENTISTRY OF CORAL SPRINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RENAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUITRAGO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-574-3822
Mailing Address - Street 1:2232 N UNIVERSITY DR STE B
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-6184
Mailing Address - Country:US
Mailing Address - Phone:954-997-5147
Mailing Address - Fax:954-692-6496
Practice Address - Street 1:2232 N UNIVERSITY DR STE B
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-6184
Practice Address - Country:US
Practice Address - Phone:954-997-5147
Practice Address - Fax:954-692-6496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-09
Last Update Date:2021-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty