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700 N Hiatus Rd #201 Pembroke Pines FL 33026-5206 | |
| (954) 517-1721 | |
| (954) 436-3628 |
| Full Name | |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 700 N Hiatus Rd, Pembroke Pines, Florida |
| Authorized Official Name and Position | Denise Anne Brady (PRESIDENT/OWNER) |
| Authorized Official Contact | 9545171721 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
700 N Hiatus Rd #201 Pembroke Pines FL 33026-5206 Ph: (954) 517-1721 | 700 N Hiatus Rd #201 Pembroke Pines FL 33026-5206 Ph: (954) 517-1721 |
| NPI Number | 1841374279 |
|---|---|
| Provider Enumeration Date | 10/24/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841374279 | NPI | - | NPPES |
| DN14692 | Other | FL | FLORIDA DENTAL LICENCE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | DN 14692 (Florida) | Primary |
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