Provider Demographics
NPI:1528722436
Name:KIDS DENTAL PLUS, P.A.
Entity type:Organization
Organization Name:KIDS DENTAL PLUS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLARREAL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-533-9639
Mailing Address - Street 1:2910 N STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33313-1912
Mailing Address - Country:US
Mailing Address - Phone:954-533-9639
Mailing Address - Fax:954-368-4316
Practice Address - Street 1:2910 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-1912
Practice Address - Country:US
Practice Address - Phone:954-533-9639
Practice Address - Fax:954-368-4316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-26
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021266000Medicaid