Provider Demographics
NPI:1962906339
Name:BMB DENTAL MANAGEMENT
Entity type:Organization
Organization Name:BMB DENTAL MANAGEMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATUTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-623-9935
Mailing Address - Street 1:11701 LAKE VICTORIA GARDENS AVE STE 2201
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2764
Mailing Address - Country:US
Mailing Address - Phone:561-623-9935
Mailing Address - Fax:
Practice Address - Street 1:11701 LAKE VICTORIA GARDENS AVE STE 2201
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2764
Practice Address - Country:US
Practice Address - Phone:561-623-9935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty