Provider Demographics
NPI:1659514479
Name:INTEGRAL DENTAL, INC.
Entity Type:Organization
Organization Name:INTEGRAL DENTAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BETANCES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-386-1096
Mailing Address - Street 1:2311 10TH AVE N STE 14
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-6605
Mailing Address - Country:US
Mailing Address - Phone:561-253-0158
Mailing Address - Fax:561-540-4430
Practice Address - Street 1:2311 10TH AVE N STE 14
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-6605
Practice Address - Country:US
Practice Address - Phone:561-253-0158
Practice Address - Fax:561-540-4430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty