Provider Demographics
NPI:1902417066
Name:PHILIP DESENZE DDS PA
Entity Type:Organization
Organization Name:PHILIP DESENZE DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:DESENZE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-785-3210
Mailing Address - Street 1:540 E MCNAB RD STE E
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-9354
Mailing Address - Country:US
Mailing Address - Phone:954-785-3210
Mailing Address - Fax:954-943-7261
Practice Address - Street 1:540 E MCNAB RD STE E
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-9354
Practice Address - Country:US
Practice Address - Phone:954-785-3210
Practice Address - Fax:954-943-7261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty