Provider Demographics
NPI:1790050417
Name:WEST SIDE PEDIATRIC DENTISTRY PA
Entity Type:Organization
Organization Name:WEST SIDE PEDIATRIC DENTISTRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:FERRER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-433-4544
Mailing Address - Street 1:16223 MIRAMAR PARKWAY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027
Mailing Address - Country:US
Mailing Address - Phone:954-433-4544
Mailing Address - Fax:954-433-4312
Practice Address - Street 1:16223 MIRAMAR PKWY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4572
Practice Address - Country:US
Practice Address - Phone:954-433-4544
Practice Address - Fax:954-433-4312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN151461223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty