Provider Demographics
NPI:1750128831
Name:THEDENTEAST, PLLC
Entity type:Organization
Organization Name:THEDENTEAST, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUNCICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINASEVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-294-2111
Mailing Address - Street 1:110 N FEDERAL HWY APT 1109
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-4452
Mailing Address - Country:US
Mailing Address - Phone:954-294-2111
Mailing Address - Fax:
Practice Address - Street 1:540 N ANDREWS AVE STE 101
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-4500
Practice Address - Country:US
Practice Address - Phone:954-669-1577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental