Provider Demographics
NPI:1841721610
Name:DENTAL BLISS P.A.
Entity type:Organization
Organization Name:DENTAL BLISS P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TOSHA
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-534-9651
Mailing Address - Street 1:9990 NW 6TH CT
Mailing Address - Street 2:BAY 16
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6157
Mailing Address - Country:US
Mailing Address - Phone:954-534-9651
Mailing Address - Fax:954-639-7835
Practice Address - Street 1:9990 NW 6TH CT
Practice Address - Street 2:BAY 16
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6157
Practice Address - Country:US
Practice Address - Phone:954-534-9651
Practice Address - Fax:954-639-7835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19661122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL08124200Medicaid