Provider Demographics
NPI:1326858697
Name:PERIODONTAL & IMPLANT EXCELLENCE
Entity type:Organization
Organization Name:PERIODONTAL & IMPLANT EXCELLENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-972-0768
Mailing Address - Street 1:2247 PALM BEACH LAKES BLVD
Mailing Address - Street 2:#207
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409
Mailing Address - Country:US
Mailing Address - Phone:561-242-2861
Mailing Address - Fax:561-242-2833
Practice Address - Street 1:2247 PALM BEACH LAKES BLVD
Practice Address - Street 2:#207
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409
Practice Address - Country:US
Practice Address - Phone:561-242-2861
Practice Address - Fax:561-242-2833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty