Provider Demographics
NPI:1831467273
Name:ASSEFF DENTAL LLC
Entity type:Organization
Organization Name:ASSEFF DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASSEFF
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-456-2678
Mailing Address - Street 1:3800 S OCEAN DR
Mailing Address - Street 2:STE 241
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33019-2927
Mailing Address - Country:US
Mailing Address - Phone:954-456-2678
Mailing Address - Fax:954-456-2711
Practice Address - Street 1:3800 S OCEAN DR
Practice Address - Street 2:STE 241
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33019-2927
Practice Address - Country:US
Practice Address - Phone:954-456-2678
Practice Address - Fax:954-456-2711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL35041223G0001X
FL170671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty