Provider Demographics
NPI:1679215149
Name:DENTAL TEAM OF WEST PALM BEACH LLC
Entity type:Organization
Organization Name:DENTAL TEAM OF WEST PALM BEACH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-204-3529
Mailing Address - Street 1:6901 OKEECHOBEE BLVD STE C5
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-2512
Mailing Address - Country:US
Mailing Address - Phone:561-684-5800
Mailing Address - Fax:561-684-8330
Practice Address - Street 1:6901 OKEECHOBEE BLVD STE C5
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-2512
Practice Address - Country:US
Practice Address - Phone:561-684-5800
Practice Address - Fax:561-684-8330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty