Provider Demographics
NPI:1720518699
Name:FAMILY DENTAL ASSOCIATES PA
Entity Type:Organization
Organization Name:FAMILY DENTAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:MINGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-554-2341
Mailing Address - Street 1:3015 BAYVIEW DR STE C
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1710
Mailing Address - Country:US
Mailing Address - Phone:954-566-1248
Mailing Address - Fax:954-566-8055
Practice Address - Street 1:6130 W ATLANTIC BLVD STE 4
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5123
Practice Address - Country:US
Practice Address - Phone:954-973-0990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty