Provider Demographics
NPI:1659013126
Name:DENTAL TEAM OF COCONUT CREEK LLC
Entity type:Organization
Organization Name:DENTAL TEAM OF COCONUT CREEK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-516-0606
Mailing Address - Street 1:1507 LYONS RD
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33063-3934
Mailing Address - Country:US
Mailing Address - Phone:954-974-4104
Mailing Address - Fax:954-974-6154
Practice Address - Street 1:1507 LYONS RD
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33063-3934
Practice Address - Country:US
Practice Address - Phone:954-974-4104
Practice Address - Fax:954-974-6154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty