Provider Demographics
NPI:1669613436
Name:HALLANDALE BEACH DENTAL PA
Entity type:Organization
Organization Name:HALLANDALE BEACH DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ARWAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-458-1133
Mailing Address - Street 1:1440 EAST HALLANDALE BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009
Mailing Address - Country:US
Mailing Address - Phone:954-458-1133
Mailing Address - Fax:954-458-5696
Practice Address - Street 1:1440 EAST HALLANDALE BEACH BLVD
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009
Practice Address - Country:US
Practice Address - Phone:954-458-1133
Practice Address - Fax:954-458-5696
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HALLANDALE BEACH DENTAL PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN130031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty