Provider Demographics
NPI:1205371259
Name:C-BAR DENTAL,LLC
Entity type:Organization
Organization Name:C-BAR DENTAL,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE CONSULTANT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GENESE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEZILME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-752-6304
Mailing Address - Street 1:1702 S DIXIE HWY
Mailing Address - Street 2:SUITE C1
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33460-5886
Mailing Address - Country:US
Mailing Address - Phone:561-223-3501
Mailing Address - Fax:
Practice Address - Street 1:1702 S DIXIE HWY
Practice Address - Street 2:SUITE C1
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-5886
Practice Address - Country:US
Practice Address - Phone:561-223-3501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-29
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty