| Lakes Mall Dental | |
|
11401 Pines Blvd Ste 220 Pembroke Pines FL 33026-4117 | |
| (954) 432-5515 | |
| (954) 432-8908 |
| Full Name | Lakes Mall Dental |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 11401 Pines Blvd, Pembroke Pines, Florida |
| Authorized Official Name and Position | Ronald L Sloane (OWNER) |
| Authorized Official Contact | 9544325515 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakes Mall Dental 11401 Pines Blvd Ste 220 Pembroke Pines FL 33026-4117 Ph: (954) 432-5515 | Lakes Mall Dental 11401 Pines Blvd Ste 220 Pembroke Pines FL 33026-4117 Ph: (954) 432-5515 |
| NPI Number | 1609062686 |
|---|---|
| Provider Enumeration Date | 09/24/2007 |
| Last Update Date | 09/24/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609062686 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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