Provider Demographics
NPI:1245835719
Name:VITAL DENTAL CENTER OF CORAL SPRINGS PLLC
Entity type:Organization
Organization Name:VITAL DENTAL CENTER OF CORAL SPRINGS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-970-9707
Mailing Address - Street 1:279 S STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-5727
Mailing Address - Country:US
Mailing Address - Phone:954-975-9779
Mailing Address - Fax:954-975-9778
Practice Address - Street 1:7426 WILES RD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-2066
Practice Address - Country:US
Practice Address - Phone:954-255-3500
Practice Address - Fax:954-255-3515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty