Provider Demographics
NPI:1619052404
Name:PEMBROKE PINES FAMILY DENTAL CENTER
Entity Type:Organization
Organization Name:PEMBROKE PINES FAMILY DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DELROY
Authorized Official - Middle Name:W
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-436-3900
Mailing Address - Street 1:P.O. BOX 260635
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026
Mailing Address - Country:US
Mailing Address - Phone:954-436-3900
Mailing Address - Fax:954-436-3628
Practice Address - Street 1:700 N. HIATUS ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026
Practice Address - Country:US
Practice Address - Phone:954-436-3900
Practice Address - Fax:954-436-3628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9016122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1881602415OtherNPI