Provider Demographics
NPI:1942063672
Name:PEDIATRIC DENTAL CENTER OF NORTH LAUDERDALE
Entity Type:Organization
Organization Name:PEDIATRIC DENTAL CENTER OF NORTH LAUDERDALE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-341-0002
Mailing Address - Street 1:7244 W MCNAB RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-5441
Mailing Address - Country:US
Mailing Address - Phone:954-341-0002
Mailing Address - Fax:
Practice Address - Street 1:7244 W MCNAB RD
Practice Address - Street 2:
Practice Address - City:NORTH LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33068-5441
Practice Address - Country:US
Practice Address - Phone:954-341-0002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty