Provider Demographics
NPI:1134354186
Name:BOCA DENTAL, INC
Entity type:Organization
Organization Name:BOCA DENTAL, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOROPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:561-226-0100
Mailing Address - Street 1:925 S FEDERAL HWY STE 315
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-6100
Mailing Address - Country:US
Mailing Address - Phone:561-226-0100
Mailing Address - Fax:561-395-1525
Practice Address - Street 1:925 S FEDERAL HWY STE 315
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-6100
Practice Address - Country:US
Practice Address - Phone:561-226-0100
Practice Address - Fax:561-395-1525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN60991223E0200X
FLDN80301223G0001X
FLDN178011223P0300X
FLDN169731223P0300X
FLDN158741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty