Provider Demographics
NPI:1588448211
Name:EKOS PALM BAY, PLLC
Entity type:Organization
Organization Name:EKOS PALM BAY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MGR
Authorized Official - Prefix:
Authorized Official - First Name:GIOVANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEJESUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-899-7115
Mailing Address - Street 1:8794 BOYNTON BEACH BLVD STE 218
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33472-4469
Mailing Address - Country:US
Mailing Address - Phone:561-899-7115
Mailing Address - Fax:
Practice Address - Street 1:195 MALABAR RD NW STE A-2
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-2962
Practice Address - Country:US
Practice Address - Phone:813-340-0116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-23
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty