Provider Demographics
NPI:1134385651
Name:DESENZE, PHILIP S
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:S
Last Name:DESENZE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 E MCNAB RD
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-9354
Mailing Address - Country:US
Mailing Address - Phone:954-785-3210
Mailing Address - Fax:954-943-9261
Practice Address - Street 1:540 E MCNAB RD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-9354
Practice Address - Country:US
Practice Address - Phone:954-785-3210
Practice Address - Fax:954-943-9261
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDN13906122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist