Provider Demographics
NPI:1295343697
Name:SOMI DENTAL GROUP OF BOCA RATON, LLC
Entity type:Organization
Organization Name:SOMI DENTAL GROUP OF BOCA RATON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ARNALDO
Authorized Official - Middle Name:ANDRE
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-338-8876
Mailing Address - Street 1:PO BOX 430587
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33243-0587
Mailing Address - Country:US
Mailing Address - Phone:305-338-8876
Mailing Address - Fax:
Practice Address - Street 1:1590 NW 10TH AVE STE 301
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1323
Practice Address - Country:US
Practice Address - Phone:053-953-4433
Practice Address - Fax:561-395-8353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty