Provider Demographics
NPI:1699964551
Name:CHILDRENS DENTAL PLACE OF WELLINGTON INC
Entity type:Organization
Organization Name:CHILDRENS DENTAL PLACE OF WELLINGTON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-790-1909
Mailing Address - Street 1:1051 G STATE ROAD #7
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414
Mailing Address - Country:US
Mailing Address - Phone:561-790-1909
Mailing Address - Fax:
Practice Address - Street 1:1051 G STATE ROAD #7
Practice Address - Street 2:SUITE 2
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414
Practice Address - Country:US
Practice Address - Phone:561-790-1909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty