Provider Demographics
NPI:1386401495
Name:BOYNTON MALL MODERN DENTISTRY, PA
Entity type:Organization
Organization Name:BOYNTON MALL MODERN DENTISTRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:K
Authorized Official - Last Name:TOLMIE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:561-210-1883
Mailing Address - Street 1:PO BOX 920050
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75392-0050
Mailing Address - Country:US
Mailing Address - Phone:561-210-1883
Mailing Address - Fax:561-228-4066
Practice Address - Street 1:701 N CONGRESS AVE STE 2B
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-3418
Practice Address - Country:US
Practice Address - Phone:561-210-1883
Practice Address - Fax:561-228-4066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty