Provider Demographics
NPI:1265910129
Name:SEDATION DENTAL SPA OF SOUTH FLORIDA, LLC
Entity type:Organization
Organization Name:SEDATION DENTAL SPA OF SOUTH FLORIDA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:DUNLAP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-946-8484
Mailing Address - Street 1:2028 E SAMPLE RD
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-7596
Mailing Address - Country:US
Mailing Address - Phone:954-946-8484
Mailing Address - Fax:954-272-7982
Practice Address - Street 1:2028 E SAMPLE RD
Practice Address - Street 2:
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064-7596
Practice Address - Country:US
Practice Address - Phone:954-946-8484
Practice Address - Fax:954-272-7982
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEDATION DENTAL SPA OF SOUTH FLORIDA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16349122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty