Provider Demographics
NPI:1528720257
Name:DENTALMED ASSOCIATES LLC
Entity type:Organization
Organization Name:DENTALMED ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FEDERICO
Authorized Official - Middle Name:
Authorized Official - Last Name:DIEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-505-7631
Mailing Address - Street 1:6100 GLADES RD STE 210
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-4371
Mailing Address - Country:US
Mailing Address - Phone:561-409-3496
Mailing Address - Fax:
Practice Address - Street 1:6100 GLADES RD STE 210
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-4371
Practice Address - Country:US
Practice Address - Phone:561-409-3496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTALMED ASSOCIATES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty