Provider Demographics
NPI:1285280024
Name:DLC DENTAL INC
Entity type:Organization
Organization Name:DLC DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOROTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LACROZE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-594-6454
Mailing Address - Street 1:4400 NW 30TH ST APT 127
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33066-2135
Mailing Address - Country:US
Mailing Address - Phone:954-594-6454
Mailing Address - Fax:
Practice Address - Street 1:6260 W OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33313-1214
Practice Address - Country:US
Practice Address - Phone:954-742-7995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental