| Lakes Mall Dental Center , Pa | |
|
11401 Pines Blvd Ste 220 Pembroke Pines FL 33026-4104 | |
| (954) 432-5515 | |
| Not Available |
| Full Name | Lakes Mall Dental Center , Pa |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 11401 Pines Blvd Ste 220, Pembroke Pines, Florida |
| Authorized Official Name and Position | Erik O Calderon (PRESIDENT) |
| Authorized Official Contact | 3059519988 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakes Mall Dental Center , Pa 1830 S Ocean Dr Apt 2204 Hallandale Beach FL 33009-7695 Ph: (305) 951-9988 | Lakes Mall Dental Center , Pa 11401 Pines Blvd Ste 220 Pembroke Pines FL 33026-4104 Ph: (954) 432-5515 |
| NPI Number | 1063757912 |
|---|---|
| Provider Enumeration Date | 12/04/2012 |
| Last Update Date | 12/04/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063757912 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 19377 (Florida) | Primary |
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