Provider Demographics
NPI:1255782553
Name:FLORIDA DENTISTRY GROUP INC.
Entity type:Organization
Organization Name:FLORIDA DENTISTRY GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:561-967-3513
Mailing Address - Street 1:115 JFK DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1152
Mailing Address - Country:US
Mailing Address - Phone:561-967-3513
Mailing Address - Fax:561-967-4705
Practice Address - Street 1:115 JFK DR
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-1152
Practice Address - Country:US
Practice Address - Phone:561-967-3513
Practice Address - Fax:561-967-4705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty