Provider Demographics
NPI:1750836821
Name:BELLE GLADE DENTAL GROUP INC
Entity Type:Organization
Organization Name:BELLE GLADE DENTAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YUDIT
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOYA
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:561-996-6165
Mailing Address - Street 1:17 W CANAL ST N
Mailing Address - Street 2:
Mailing Address - City:BELLE GLADE
Mailing Address - State:FL
Mailing Address - Zip Code:33430-3078
Mailing Address - Country:US
Mailing Address - Phone:561-996-6165
Mailing Address - Fax:561-983-8154
Practice Address - Street 1:17 W CANAL ST N
Practice Address - Street 2:
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-3078
Practice Address - Country:US
Practice Address - Phone:561-996-6165
Practice Address - Fax:561-983-8154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty