Provider Demographics
NPI:1386450021
Name:3M FAMILY DENTISTRY LLC
Entity type:Organization
Organization Name:3M FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLDAVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-787-4029
Mailing Address - Street 1:14653 NEWTONMORE LN
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-5641
Mailing Address - Country:US
Mailing Address - Phone:973-787-4029
Mailing Address - Fax:
Practice Address - Street 1:560 N WASHINGTON BLVD STE B
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-4253
Practice Address - Country:US
Practice Address - Phone:973-787-4029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-07
Last Update Date:2024-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty