Provider Demographics
NPI:1366715716
Name:PIKE PEDIATRIC DENTISTRY PA
Entity type:Organization
Organization Name:PIKE PEDIATRIC DENTISTRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PIKE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-856-9955
Mailing Address - Street 1:1865 NW BOCA RATON BLVD
Mailing Address - Street 2:STE 102
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-1638
Mailing Address - Country:US
Mailing Address - Phone:561-347-7006
Mailing Address - Fax:
Practice Address - Street 1:1865 NW BOCA RATON BLVD
Practice Address - Street 2:STE 102
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-1638
Practice Address - Country:US
Practice Address - Phone:561-347-7006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN175961223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty