Provider Demographics
NPI:1700492626
Name:LAKE WORTH DENTISTRY
Entity Type:Organization
Organization Name:LAKE WORTH DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NAVED
Authorized Official - Middle Name:
Authorized Official - Last Name:FATMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-457-3690
Mailing Address - Street 1:3003 W YAMATO RD STE C5
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-5337
Mailing Address - Country:US
Mailing Address - Phone:786-457-3690
Mailing Address - Fax:
Practice Address - Street 1:6427 LAKE WORTH RD
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-2900
Practice Address - Country:US
Practice Address - Phone:561-998-0727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental