Provider Demographics
NPI:1780128033
Name:PALM BEACH COSMETIC DENTISTRY
Entity type:Organization
Organization Name:PALM BEACH COSMETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONCRIEFFE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:718-801-0187
Mailing Address - Street 1:2150 LAKE IDA RD
Mailing Address - Street 2:SUITE #8
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-2443
Mailing Address - Country:US
Mailing Address - Phone:561-272-4110
Mailing Address - Fax:561-272-4174
Practice Address - Street 1:2150 LAKE IDA RD
Practice Address - Street 2:SUITE #8
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-2443
Practice Address - Country:US
Practice Address - Phone:561-272-4110
Practice Address - Fax:561-272-4174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21023261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental