Provider Demographics
NPI:1720709280
Name:CMT DENTAL PA
Entity Type:Organization
Organization Name:CMT DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:MADISON
Authorized Official - Last Name:DUNN-TACKETT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-745-1174
Mailing Address - Street 1:542 N US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-2372
Mailing Address - Country:US
Mailing Address - Phone:561-745-1174
Mailing Address - Fax:561-744-9713
Practice Address - Street 1:542 N US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:TEQUESTA
Practice Address - State:FL
Practice Address - Zip Code:33469-2372
Practice Address - Country:US
Practice Address - Phone:561-745-1174
Practice Address - Fax:561-744-9713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental