Provider Demographics
NPI:1588905384
Name:DOCTOR'S DENTAL GROUP
Entity type:Organization
Organization Name:DOCTOR'S DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:LIZASO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-917-7600
Mailing Address - Street 1:3850 COCONUT CREEK PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33066-1600
Mailing Address - Country:US
Mailing Address - Phone:954-917-7600
Mailing Address - Fax:
Practice Address - Street 1:3850 COCONUT CREEK PKWY STE C
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33066-1600
Practice Address - Country:US
Practice Address - Phone:954-917-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty