Provider Demographics
NPI:1831736800
Name:SQUARE ONE DENTISTRY LLC
Entity type:Organization
Organization Name:SQUARE ONE DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NAVED
Authorized Official - Middle Name:
Authorized Official - Last Name:FATMI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:786-457-3690
Mailing Address - Street 1:3571 NW FEDERAL HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:JENSON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957
Mailing Address - Country:US
Mailing Address - Phone:786-457-3690
Mailing Address - Fax:
Practice Address - Street 1:3571 NW FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-4454
Practice Address - Country:US
Practice Address - Phone:786-457-3690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental