Provider Demographics
NPI:1760172852
Name:FLORIDA DENTAL STUDIO, PA
Entity Type:Organization
Organization Name:FLORIDA DENTAL STUDIO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAZARO
Authorized Official - Middle Name:
Authorized Official - Last Name:GAVILLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-586-3767
Mailing Address - Street 1:2701 NE 14TH STREET CSWY STE 4
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-3535
Mailing Address - Country:US
Mailing Address - Phone:754-205-4900
Mailing Address - Fax:754-205-4799
Practice Address - Street 1:2701 NE 14TH STREET CSWY STE 4
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-3535
Practice Address - Country:US
Practice Address - Phone:754-205-4900
Practice Address - Fax:754-205-4799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty