Provider Demographics
NPI:1609548833
Name:CHILDRENS DENTISTRY OF AMERICA LLC
Entity type:Organization
Organization Name:CHILDRENS DENTISTRY OF AMERICA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GISLEDA
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MS
Authorized Official - Phone:954-775-0723
Mailing Address - Street 1:7663 W SAMPLE RD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4718
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:754-241-0242
Practice Address - Street 1:7663 W SAMPLE RD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4718
Practice Address - Country:US
Practice Address - Phone:954-755-0723
Practice Address - Fax:754-241-0242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-05
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101344800Medicaid