Provider Demographics
NPI:1306450614
Name:IDENTAL OF BOYNTON BEACH, PLLC
Entity type:Organization
Organization Name:IDENTAL OF BOYNTON BEACH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:FLOYD
Authorized Official - Last Name:BATTLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:727-327-5561
Mailing Address - Street 1:1507 LYONS RD
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33063-3934
Mailing Address - Country:US
Mailing Address - Phone:954-974-4101
Mailing Address - Fax:954-974-6154
Practice Address - Street 1:8256 S JOG RD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33472-2938
Practice Address - Country:US
Practice Address - Phone:954-974-4101
Practice Address - Fax:954-974-6154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental