| Pembroke Dental Associates | |
|
12251 Taft St Suite 404 Pembroke Pines FL 33026-1901 | |
| (954) 432-7077 | |
| (954) 433-0748 |
| Full Name | Pembroke Dental Associates |
|---|---|
| Speciality | Dentist - Endodontics |
| Location | 12251 Taft St, Pembroke Pines, Florida |
| Authorized Official Name and Position | Edgar J Porras (PRESIDENT) |
| Authorized Official Contact | 9544327077 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pembroke Dental Associates 12251 Taft St Suite 404 Pembroke Pines FL 33026-1901 Ph: (954) 432-7077 | Pembroke Dental Associates 12251 Taft St Suite 404 Pembroke Pines FL 33026-1901 Ph: (954) 432-7077 |
| NPI Number | 1154694891 |
|---|---|
| Provider Enumeration Date | 02/10/2012 |
| Last Update Date | 02/10/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154694891 | NPI | - | NPPES |
| 001313400 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223E0200X | Dentist - Endodontics | DN11671 (Florida) | Primary |
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