Provider Demographics
NPI:1386075349
Name:ADVANCED PROSTHODONTICS OF BOCA RATON, PA
Entity type:Organization
Organization Name:ADVANCED PROSTHODONTICS OF BOCA RATON, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELAD
Authorized Official - Middle Name:NAJI
Authorized Official - Last Name:GHALLOUB
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-347-5002
Mailing Address - Street 1:7000 W CAMINO REAL
Mailing Address - Street 2:SUITE 130
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-5532
Mailing Address - Country:US
Mailing Address - Phone:561-347-5002
Mailing Address - Fax:561-347-5020
Practice Address - Street 1:7000 W CAMINO REAL
Practice Address - Street 2:SUITE 130
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-5532
Practice Address - Country:US
Practice Address - Phone:561-347-5002
Practice Address - Fax:561-347-5020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16343122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty