Provider Demographics
NPI:1679960231
Name:ROADS DENTAL SPECIALTY GROUP
Entity Type:Organization
Organization Name:ROADS DENTAL SPECIALTY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:C
Authorized Official - Last Name:EAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-856-1134
Mailing Address - Street 1:1378 CORAL WAY
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2943
Mailing Address - Country:US
Mailing Address - Phone:305-856-1134
Mailing Address - Fax:305-239-9452
Practice Address - Street 1:1378 CORAL WAY
Practice Address - Street 2:5TH FLOOR
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2943
Practice Address - Country:US
Practice Address - Phone:305-856-1134
Practice Address - Fax:305-239-9452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty