Provider Demographics
NPI:1306122189
Name:DENTAL CONCEPTS PA
Entity type:Organization
Organization Name:DENTAL CONCEPTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAVERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-241-1010
Mailing Address - Street 1:2500 N MILITARY TRL
Mailing Address - Street 2:SUITE 230
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6344
Mailing Address - Country:US
Mailing Address - Phone:561-241-1010
Mailing Address - Fax:561-241-1140
Practice Address - Street 1:2500 N MILITARY TRL
Practice Address - Street 2:SUITE 230
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6344
Practice Address - Country:US
Practice Address - Phone:561-241-1010
Practice Address - Fax:561-241-1140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5640261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental