Provider Demographics
NPI:1952518557
Name:PREVENTIVE DENTISTRY FOR CHILDREN PA
Entity Type:Organization
Organization Name:PREVENTIVE DENTISTRY FOR CHILDREN PA
Other - Org Name:PREVENTIVE DENTISTRY FOR CHILDREN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:MARIE-JEANNE
Authorized Official - Last Name:VEDRENNE-RANGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-743-4670
Mailing Address - Street 1:9713 OVERSEAS HWY
Mailing Address - Street 2:
Mailing Address - City:MARATHON
Mailing Address - State:FL
Mailing Address - Zip Code:33050-3342
Mailing Address - Country:US
Mailing Address - Phone:305-743-4670
Mailing Address - Fax:305-743-4899
Practice Address - Street 1:9713 OVERSEAS HWY
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-3342
Practice Address - Country:US
Practice Address - Phone:305-743-4670
Practice Address - Fax:305-743-4899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2009-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 170351223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty