Provider Demographics
NPI:1912451493
Name:TAMARAC FAMILY DENTAL PA
Entity Type:Organization
Organization Name:TAMARAC FAMILY DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:SAN JORGE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:786-853-5510
Mailing Address - Street 1:7351 W OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33319-7107
Mailing Address - Country:US
Mailing Address - Phone:954-742-5055
Mailing Address - Fax:954-742-5341
Practice Address - Street 1:7351 W OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319-7107
Practice Address - Country:US
Practice Address - Phone:954-742-5055
Practice Address - Fax:954-742-5341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty