Provider Demographics
NPI:1457770778
Name:PEDIATRIC DENTAL LAND
Entity Type:Organization
Organization Name:PEDIATRIC DENTAL LAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NESTOR
Authorized Official - Middle Name:H
Authorized Official - Last Name:D'ALESSANDRIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-414-8018
Mailing Address - Street 1:8320 W SUNRISE BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-5435
Mailing Address - Country:US
Mailing Address - Phone:954-414-8018
Mailing Address - Fax:
Practice Address - Street 1:8320 W SUNRISE BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-5435
Practice Address - Country:US
Practice Address - Phone:954-414-8018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN190591223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty