Provider Demographics
NPI:1316429780
Name:DENTAL ARTS OF BOYNTON BEACH
Entity type:Organization
Organization Name:DENTAL ARTS OF BOYNTON BEACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMENICK
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:CERULLO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-767-9595
Mailing Address - Street 1:10150 HAGEN RANCH RD STE 202
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-3776
Mailing Address - Country:US
Mailing Address - Phone:561-767-9595
Mailing Address - Fax:561-767-9569
Practice Address - Street 1:10150 HAGEN RANCH RD STE 202
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3776
Practice Address - Country:US
Practice Address - Phone:561-767-9595
Practice Address - Fax:561-767-9569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-03
Last Update Date:2018-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty