Provider Demographics
NPI:1962658583
Name:AVENTURA ENDODONTIC GROUP, LLC
Entity Type:Organization
Organization Name:AVENTURA ENDODONTIC GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:J
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-933-0001
Mailing Address - Street 1:19495 BISCAYNE BLVD.
Mailing Address - Street 2:SUITE #404
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180
Mailing Address - Country:US
Mailing Address - Phone:305-933-0001
Mailing Address - Fax:305-933-2122
Practice Address - Street 1:19495 BISCAYNE BLVD
Practice Address - Street 2:SUITE #404
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-2318
Practice Address - Country:US
Practice Address - Phone:305-933-0001
Practice Address - Fax:305-933-2122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL41251223E0200X
FLDN163451223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty