Provider Demographics
NPI:1669780284
Name:CAPE SIDE DENTAL P A
Entity type:Organization
Organization Name:CAPE SIDE DENTAL P A
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:BERESFORD
Authorized Official - Last Name:ARTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD,FAGD
Authorized Official - Phone:321-727-0011
Mailing Address - Street 1:3265 BAYSIDE LAKES BLVD SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-6872
Mailing Address - Country:US
Mailing Address - Phone:321-727-0011
Mailing Address - Fax:321-727-0014
Practice Address - Street 1:3265 BAYSIDE LAKES BLVD SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-6872
Practice Address - Country:US
Practice Address - Phone:321-727-0011
Practice Address - Fax:321-727-0014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-16
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18108122300000X
FLDN15346122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty