Provider Demographics
NPI:1295239952
Name:DENTAL SERVICES OF WESTON,PA
Entity type:Organization
Organization Name:DENTAL SERVICES OF WESTON,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:OTERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-217-4939
Mailing Address - Street 1:25001 SW 127TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-5834
Mailing Address - Country:US
Mailing Address - Phone:305-258-9838
Mailing Address - Fax:305-258-9872
Practice Address - Street 1:2701 EXECUTIVE PARK DR STE 4
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3632
Practice Address - Country:US
Practice Address - Phone:954-217-4939
Practice Address - Fax:954-217-4938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty