Provider Demographics
NPI:1780325886
Name:DEERFIELD BEACH DENTISTRY LLC
Entity type:Organization
Organization Name:DEERFIELD BEACH DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAVED
Authorized Official - Middle Name:
Authorized Official - Last Name:FATMI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:786-457-3690
Mailing Address - Street 1:3003 W YAMATO RD STE C5
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-5337
Mailing Address - Country:US
Mailing Address - Phone:561-998-0727
Mailing Address - Fax:
Practice Address - Street 1:1100 S FEDERAL HWY STE 100
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-7000
Practice Address - Country:US
Practice Address - Phone:561-998-0727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN18878OtherDENTAL LICENSE