Provider Demographics
NPI:1255191300
Name:DYNAMIC LIVES
Entity type:Organization
Organization Name:DYNAMIC LIVES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMANPREET
Authorized Official - Middle Name:KAUR
Authorized Official - Last Name:RANDHAWA-KOHLI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:386-334-6085
Mailing Address - Street 1:464 S RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-4928
Mailing Address - Country:US
Mailing Address - Phone:386-255-8866
Mailing Address - Fax:
Practice Address - Street 1:464 S RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-4928
Practice Address - Country:US
Practice Address - Phone:386-255-8866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental