Provider Demographics
NPI:1154576379
Name:MID-COUNTY DENTAL CENTER INC
Entity type:Organization
Organization Name:MID-COUNTY DENTAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GUZAUSKAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:561-640-7600
Mailing Address - Street 1:4047 OKEECHOBEE BLVD
Mailing Address - Street 2:SUITE 219
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-3239
Mailing Address - Country:US
Mailing Address - Phone:561-640-7600
Mailing Address - Fax:561-640-8265
Practice Address - Street 1:4047 OKEECHOBEE BLVD
Practice Address - Street 2:SUITE 219
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-3239
Practice Address - Country:US
Practice Address - Phone:561-640-7600
Practice Address - Fax:561-640-8265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5388122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty