Provider Demographics
NPI:1477265056
Name:BOCA RATON DENTAL SPECIALISTS PLLC
Entity type:Organization
Organization Name:BOCA RATON DENTAL SPECIALISTS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-270-6070
Mailing Address - Street 1:19615 STATE ROAD 7 STE 34
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-4700
Mailing Address - Country:US
Mailing Address - Phone:561-270-6070
Mailing Address - Fax:
Practice Address - Street 1:19615 STATE ROAD 7 STE 34
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33498-4700
Practice Address - Country:US
Practice Address - Phone:561-270-6070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-15
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty