Provider Demographics
NPI:1760705263
Name:FIRST CARE DENTAL OF PALM BEACH, PA
Entity Type:Organization
Organization Name:FIRST CARE DENTAL OF PALM BEACH, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMINH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:561-582-5273
Mailing Address - Street 1:11076 SUNSET RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33473-4868
Mailing Address - Country:US
Mailing Address - Phone:561-582-5273
Mailing Address - Fax:
Practice Address - Street 1:4911 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33405-2926
Practice Address - Country:US
Practice Address - Phone:561-582-5273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-11
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN12630122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001975300Medicaid