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12169 Pembroke Rd Pembroke Pines FL 33025-1727 | |
| (954) 505-3269 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 12169 Pembroke Rd, Pembroke Pines, Florida |
| Authorized Official Name and Position | Daniel Rodriguez (ADMINSTRATOR) |
| Authorized Official Contact | 9545053269 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
14201 W Sunrise Blvd Ste 207 Sunrise FL 33323-3207 Ph: (954) 505-5000 | 12169 Pembroke Rd Pembroke Pines FL 33025-1727 Ph: (954) 505-3269 |
| NPI Number | 1356892467 |
|---|---|
| Provider Enumeration Date | 10/24/2016 |
| Last Update Date | 10/24/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356892467 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DN21583 (Florida) | Primary |
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