Provider Demographics
NPI:1154574309
Name:BIG TOOTH BOCA, LLC.
Entity type:Organization
Organization Name:BIG TOOTH BOCA, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:JACQUELINE
Authorized Official - Last Name:GALVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:561-482-8000
Mailing Address - Street 1:21301 POWERLINE RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-2388
Mailing Address - Country:US
Mailing Address - Phone:561-482-8000
Mailing Address - Fax:561-488-2936
Practice Address - Street 1:21301 POWERLINE RD
Practice Address - Street 2:SUITE 208
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-2388
Practice Address - Country:US
Practice Address - Phone:561-482-8000
Practice Address - Fax:561-488-2936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-01
Last Update Date:2008-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL161651223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty