| Boulevard Center For Advanced Dentistry | |
|
1343 Se Port St Lucie Blvd Port St Lucie FL 34952-5366 | |
| (772) 337-1111 | |
| Not Available |
| Full Name | Boulevard Center For Advanced Dentistry |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1343 Se Port St Lucie Blvd, Port St Lucie, Florida |
| Authorized Official Name and Position | Jerome Vitale (DENTIST/OWNER) |
| Authorized Official Contact | 7723371111 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Boulevard Center For Advanced Dentistry 1343 Se Port St Lucie Blvd Port St Lucie FL 34952-5366 Ph: () - | Boulevard Center For Advanced Dentistry 1343 Se Port St Lucie Blvd Port St Lucie FL 34952-5366 Ph: (772) 337-1111 |
| NPI Number | 1275906232 |
|---|---|
| Provider Enumeration Date | 11/12/2015 |
| Last Update Date | 11/12/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275906232 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | DN13975 (Florida) | Primary |
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