Provider Demographics
NPI:1942635693
Name:M COSMETIC AND FAMILY DENTISTRY, PA
Entity Type:Organization
Organization Name:M COSMETIC AND FAMILY DENTISTRY, PA
Other - Org Name:M DENTAL COSMETIC AND FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:MEINBACH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:561-653-1163
Mailing Address - Street 1:425 GREENWICH CIR STE 101-102
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-4807
Mailing Address - Country:US
Mailing Address - Phone:561-653-1163
Mailing Address - Fax:
Practice Address - Street 1:425 GREENWICH CIR STE 101-102
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4807
Practice Address - Country:US
Practice Address - Phone:561-653-1163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL176901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty