Provider Demographics
NPI:1881836401
Name:BROWARD DENTAL SPA
Entity Type:Organization
Organization Name:BROWARD DENTAL SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-351-0406
Mailing Address - Street 1:2161 E COMMERCIAL BLVD FL 1
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-3810
Mailing Address - Country:US
Mailing Address - Phone:954-351-0406
Mailing Address - Fax:
Practice Address - Street 1:2161 E COMMERCIAL BLVD FL 1
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3810
Practice Address - Country:US
Practice Address - Phone:954-351-0406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty