Provider Demographics
NPI:1992315295
Name:AMERICAN PEDIATRIC DENTAL BOCA, INC
Entity type:Organization
Organization Name:AMERICAN PEDIATRIC DENTAL BOCA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-417-1337
Mailing Address - Street 1:9181 GLADES RD STE 120
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-3940
Mailing Address - Country:US
Mailing Address - Phone:954-417-1337
Mailing Address - Fax:954-998-4750
Practice Address - Street 1:9181 GLADES RD STE 120
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-3940
Practice Address - Country:US
Practice Address - Phone:954-417-1337
Practice Address - Fax:954-998-4750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty