Provider Demographics
NPI:1972371631
Name:NATIONAL DENTEX LLC
Entity type:Organization
Organization Name:NATIONAL DENTEX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. GLOBAL DIR. COMPLIANCE & SAFETY
Authorized Official - Prefix:
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FONSECA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-717-1055
Mailing Address - Street 1:4400 PGA BLVD STE 700
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6560
Mailing Address - Country:US
Mailing Address - Phone:786-717-1055
Mailing Address - Fax:
Practice Address - Street 1:5830 CROSSROADS COMMERCE PKWY SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-9572
Practice Address - Country:US
Practice Address - Phone:616-261-9191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes292200000XLaboratoriesDental Laboratory