Provider Demographics
NPI:1245676584
Name:JAMILY F PEDRO , DMD, PA
Entity type:Organization
Organization Name:JAMILY F PEDRO , DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMILY
Authorized Official - Middle Name:F
Authorized Official - Last Name:PEDRO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-394-2592
Mailing Address - Street 1:7050 W PALMETTO PARK ROAD
Mailing Address - Street 2:SUITE 52
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433
Mailing Address - Country:US
Mailing Address - Phone:561-394-2592
Mailing Address - Fax:
Practice Address - Street 1:7050 W PALMETTO PARK ROAD
Practice Address - Street 2:SUITE 52
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433
Practice Address - Country:US
Practice Address - Phone:561-394-2592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN195181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty