Provider Demographics
NPI:1699199315
Name:PROSPERITY DENTAL GROUP
Entity Type:Organization
Organization Name:PROSPERITY DENTAL GROUP
Other - Org Name:FLORIDA DENTAL INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROYZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-848-0097
Mailing Address - Street 1:1535 PROSPERITY FARMS RD
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33403-2025
Mailing Address - Country:US
Mailing Address - Phone:561-848-0087
Mailing Address - Fax:561-848-0987
Practice Address - Street 1:1535 PROSPERITY FARMS RD
Practice Address - Street 2:
Practice Address - City:LAKE PARK
Practice Address - State:FL
Practice Address - Zip Code:33403-2025
Practice Address - Country:US
Practice Address - Phone:561-848-0087
Practice Address - Fax:561-848-0987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-17
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17148122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty