Provider Demographics
NPI:1487094934
Name:AMERICAN DENTAL OF FL-FORT LAUDERDALE
Entity type:Organization
Organization Name:AMERICAN DENTAL OF FL-FORT LAUDERDALE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:KERNS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-938-2447
Mailing Address - Street 1:2740 E COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4113
Mailing Address - Country:US
Mailing Address - Phone:954-938-2447
Mailing Address - Fax:954-938-3527
Practice Address - Street 1:2740 E COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4113
Practice Address - Country:US
Practice Address - Phone:954-938-2447
Practice Address - Fax:954-938-3527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN171501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty