Provider Demographics
NPI:1790836294
Name:PALM TREE DENTAL CENTER
Entity Type:Organization
Organization Name:PALM TREE DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:WITULSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:772-778-5773
Mailing Address - Street 1:6200 20TH ST STE 292
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32966-1079
Mailing Address - Country:US
Mailing Address - Phone:772-778-5773
Mailing Address - Fax:772-778-6944
Practice Address - Street 1:6200 20TH ST STE 292
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32966-1079
Practice Address - Country:US
Practice Address - Phone:772-778-5773
Practice Address - Fax:772-778-6944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00133381223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty