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Provider Information for 1700329968

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: MALE

Individual NPI: 1700329968

Calendar   Last Updated:  2017-12-28
  Certification Date: 


Name Value
NPI 1700329968
Enumeration Date 2016-11-21
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 10 10TH ST NW SUITE 100
ATLANTA, GA 30309-3848
United States

Phone: 404-892-2337 | Fax:
View Map External Link
Primary Practice Address 4756 N CONGRESS AVE
BOYNTON BEACH, FL 33426-7951
United States

Phone: 561-868-0900 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice FL DN23067