Provider Demographics
NPI:1851748149
Name:JVL DENTAL CREATIONS, PA
Entity Type:Organization
Organization Name:JVL DENTAL CREATIONS, PA
Other - Org Name:SUNSET SMILE CREATIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PERIODONTIST/VICEPRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:LUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-595-5655
Mailing Address - Street 1:10271 SW 72ND ST # D106
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3024
Mailing Address - Country:US
Mailing Address - Phone:305-595-5655
Mailing Address - Fax:
Practice Address - Street 1:10271 SW 72ND ST # D106
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3024
Practice Address - Country:US
Practice Address - Phone:305-595-5655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty