Provider Demographics
NPI:1730289612
Name:DENTAL HEALTH GROUP
Entity Type:Organization
Organization Name:DENTAL HEALTH GROUP
Other - Org Name:DENTAL HEALTH GROUP @ CORAL SPRINGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BRODY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-652-6313
Mailing Address - Street 1:20295 NW 2ND AVE
Mailing Address - Street 2:210
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-2550
Mailing Address - Country:US
Mailing Address - Phone:305-652-6313
Mailing Address - Fax:305-652-9940
Practice Address - Street 1:1881 N UNIVERSITY DR
Practice Address - Street 2:208
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-8915
Practice Address - Country:US
Practice Address - Phone:954-755-1014
Practice Address - Fax:954-755-1028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN102191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty