Provider Demographics
NPI:1770354847
Name:JET DENTAL OF FLORIDA PLLC
Entity type:Organization
Organization Name:JET DENTAL OF FLORIDA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:I
Authorized Official - Last Name:BRATMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:561-495-8181
Mailing Address - Street 1:1881 W TRAVERSE PKWY STE E102
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-5986
Mailing Address - Country:US
Mailing Address - Phone:801-430-9262
Mailing Address - Fax:801-430-9262
Practice Address - Street 1:3479 NE 163RD ST STE 1184
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-4426
Practice Address - Country:US
Practice Address - Phone:801-430-9262
Practice Address - Fax:801-430-9262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty