Provider Demographics
NPI:1457088916
Name:DENTAL IMPLANT 24HRS PEMBROKE PINES LLC
Entity Type:Organization
Organization Name:DENTAL IMPLANT 24HRS PEMBROKE PINES LLC
Other - Org Name:DR. IMPLANT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBERTO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:786-683-0698
Mailing Address - Street 1:8250 SW 180TH ST
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-6130
Mailing Address - Country:US
Mailing Address - Phone:786-229-0698
Mailing Address - Fax:
Practice Address - Street 1:9050 PINES BLVD STE 420
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6443
Practice Address - Country:US
Practice Address - Phone:954-697-4533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-04
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty