Provider Demographics
NPI:1841893062
Name:M I PICKRON PA
Entity type:Organization
Organization Name:M I PICKRON PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKRON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-824-5190
Mailing Address - Street 1:611 NE 12TH TER APT 1
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-3264
Mailing Address - Country:US
Mailing Address - Phone:404-824-5190
Mailing Address - Fax:
Practice Address - Street 1:6476 LAKE WORTH RD
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-3008
Practice Address - Country:US
Practice Address - Phone:404-824-5190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty