Provider Demographics
NPI:1770754111
Name:BOYNTON LAKES DENTAL, PA
Entity type:Organization
Organization Name:BOYNTON LAKES DENTAL, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SAITTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:561-964-2002
Mailing Address - Street 1:6099 FOREST HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33413
Mailing Address - Country:US
Mailing Address - Phone:561-964-2002
Mailing Address - Fax:561-964-9606
Practice Address - Street 1:6609 FOREST HILL BLVD
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33413-3303
Practice Address - Country:US
Practice Address - Phone:561-964-2002
Practice Address - Fax:561-964-9606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0011357122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN0011357OtherDENTAL OFFICE