Provider Demographics
NPI:1629536818
Name:DENTISTS OF FORT LAUDERDALE, PA
Entity Type:Organization
Organization Name:DENTISTS OF FORT LAUDERDALE, PA
Other - Org Name:DENTISTS OF FORT LAUDERDALE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:ALESSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIGILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-947-1458
Mailing Address - Street 1:PO BOX 920050
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75392-0050
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1865 CORDOVA RD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2198
Practice Address - Country:US
Practice Address - Phone:954-947-1458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-06
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty