Provider Demographics
NPI:1790880151
Name:DENTAL CENTER AT BAPTIST MEDICAL PLAZA
Entity Type:Organization
Organization Name:DENTAL CENTER AT BAPTIST MEDICAL PLAZA
Other - Org Name:MAIN STREET CHILDREN'S DENTISTRY AT MEDICAL PLAZA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARRISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-274-2499
Mailing Address - Street 1:8750 SW 144TH ST STE 205
Mailing Address - Street 2:
Mailing Address - City:VILLAGE OF PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33176-7230
Mailing Address - Country:US
Mailing Address - Phone:305-969-3122
Mailing Address - Fax:
Practice Address - Street 1:8750 SW 144TH ST STE 205
Practice Address - Street 2:
Practice Address - City:VILLAGE OF PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33176-7230
Practice Address - Country:US
Practice Address - Phone:305-969-3122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty