Provider Demographics
NPI:1972168839
Name:THE KIDS DENTAL PRACTICE
Entity Type:Organization
Organization Name:THE KIDS DENTAL PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-534-6260
Mailing Address - Street 1:15065 STATE ROAD 7
Mailing Address - Street 2:STE 650
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15065 S STATE ROAD 7 STE 650
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-4110
Practice Address - Country:US
Practice Address - Phone:561-840-5437
Practice Address - Fax:561-840-1042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-07
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013292400Medicaid