Provider Demographics
NPI:1720487960
Name:HALLANDALE BEACH DENTAL CARE
Entity Type:Organization
Organization Name:HALLANDALE BEACH DENTAL CARE
Other - Org Name:THE CENTER OF ESTHETIC AND LASER DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMISHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DENIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-752-4450
Mailing Address - Street 1:2100 E HALLANDALE BEACH BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-3765
Mailing Address - Country:US
Mailing Address - Phone:954-456-5611
Mailing Address - Fax:
Practice Address - Street 1:2100 E HALLANDALE BEACH BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-3765
Practice Address - Country:US
Practice Address - Phone:954-456-5611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19141122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty