| The Green Dental Studio Pa | |
|
1330 Se 4th Ave Ste L Fort Lauderdale FL 33316-1958 | |
| (954) 990-8389 | |
| Not Available |
| Full Name | The Green Dental Studio Pa |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1330 Se 4th Ave Ste L, Fort Lauderdale, Florida |
| Authorized Official Name and Position | Jose Antonio Alfonso (OWNER) |
| Authorized Official Contact | 7866148927 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Green Dental Studio Pa 1330 Se 4th Ave Ste L Fort Lauderdale FL 33316-1958 Ph: (954) 990-8389 | The Green Dental Studio Pa 1330 Se 4th Ave Ste L Fort Lauderdale FL 33316-1958 Ph: (954) 990-8389 |
| NPI Number | 1134825052 |
|---|---|
| Provider Enumeration Date | 02/02/2023 |
| Last Update Date | 02/02/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134825052 | NPI | - | NPPES |
| 1760008486 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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