Provider Demographics
NPI:1972019404
Name:SEDA DENTAL OF BOCA RATON, P.A.
Entity Type:Organization
Organization Name:SEDA DENTAL OF BOCA RATON, P.A.
Other - Org Name:SEDA DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:RUBINSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-738-9007
Mailing Address - Street 1:10075 S JOG RD STE 108
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-3532
Mailing Address - Country:US
Mailing Address - Phone:561-738-9007
Mailing Address - Fax:561-738-9963
Practice Address - Street 1:6063 SW 18TH ST STE 109
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-7118
Practice Address - Country:US
Practice Address - Phone:561-257-1007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty