Provider Demographics
NPI:1316094485
Name:CHILDRENS DENTISTRY PA
Entity type:Organization
Organization Name:CHILDRENS DENTISTRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:RODOLFO
Authorized Official - Last Name:BENDECK
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:561-626-9887
Mailing Address - Street 1:200 VILLAGE SQUARE XING
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-3224
Mailing Address - Country:US
Mailing Address - Phone:561-626-9887
Mailing Address - Fax:561-627-4451
Practice Address - Street 1:200 VILLAGE SQUARE XING
Practice Address - Street 2:SUITE 101
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-3224
Practice Address - Country:US
Practice Address - Phone:561-626-9887
Practice Address - Fax:561-627-4451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN104451223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty