Provider Demographics
NPI:1245405901
Name:ADVANCED SCAN LLC
Entity type:Organization
Organization Name:ADVANCED SCAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:561-499-9049
Mailing Address - Street 1:16244 SO MILITARY TRAIL
Mailing Address - Street 2:STE 260
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6505
Mailing Address - Country:US
Mailing Address - Phone:561-499-9049
Mailing Address - Fax:561-381-7775
Practice Address - Street 1:16244 S MILITARY TRL
Practice Address - Street 2:STE 260
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6534
Practice Address - Country:US
Practice Address - Phone:561-499-9049
Practice Address - Fax:561-381-7775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9285122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty