| Advanced Dental Wellness Center | |
|
104 Se 1st St Fort Lauderdale FL 33301-1924 | |
| (954) 525-5662 | |
| (954) 525-5251 |
| Full Name | Advanced Dental Wellness Center |
|---|---|
| Speciality | Dentist |
| Location | 104 Se 1st St, Fort Lauderdale, Florida |
| Authorized Official Name and Position | Boris Lipovetskiy (OWNER) |
| Authorized Official Contact | 9545255662 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Dental Wellness Center 104 Se 1st St Fort Lauderdale FL 33301-1924 Ph: (954) 525-5662 | Advanced Dental Wellness Center 104 Se 1st St Fort Lauderdale FL 33301-1924 Ph: (954) 525-5662 |
| NPI Number | 1730694191 |
|---|---|
| Provider Enumeration Date | 12/07/2017 |
| Last Update Date | 12/07/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730694191 | NPI | - | NPPES |
| 1629113808 | Other | FL | GROUP NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DN21039 (Florida) | Primary |
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