Provider Demographics
NPI:1659521698
Name:UNIVERSITY DENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:UNIVERSITY DENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:BELLOMIO
Authorized Official - Last Name:COMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-679-3181
Mailing Address - Street 1:2879 S UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-1440
Mailing Address - Country:US
Mailing Address - Phone:954-474-2422
Mailing Address - Fax:954-474-1966
Practice Address - Street 1:2879 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-1440
Practice Address - Country:US
Practice Address - Phone:954-474-2422
Practice Address - Fax:954-474-1966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty