Provider Demographics
NPI:1801300066
Name:PREFERRED DENTAL CARE PA
Entity type:Organization
Organization Name:PREFERRED DENTAL CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VADIM
Authorized Official - Middle Name:
Authorized Official - Last Name:VALDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-810-6226
Mailing Address - Street 1:2263 S UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-5825
Mailing Address - Country:US
Mailing Address - Phone:954-475-0700
Mailing Address - Fax:
Practice Address - Street 1:2263 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-5825
Practice Address - Country:US
Practice Address - Phone:954-475-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17761122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL076461200Medicaid