Provider Demographics
NPI:1740960152
Name:PARADISE DENTAL STUDIO
Entity type:Organization
Organization Name:PARADISE DENTAL STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ECKARDT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-317-9221
Mailing Address - Street 1:530 NW 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-8137
Mailing Address - Country:US
Mailing Address - Phone:954-317-9221
Mailing Address - Fax:954-800-9791
Practice Address - Street 1:530 NW 7TH AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-8137
Practice Address - Country:US
Practice Address - Phone:954-317-9221
Practice Address - Fax:954-800-9791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental