Provider Demographics
NPI:1871975813
Name:A&B PEDIATRIC DENTISTS LLC
Entity type:Organization
Organization Name:A&B PEDIATRIC DENTISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MAJKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-909-0350
Mailing Address - Street 1:6370 N STATE ROAD 7
Mailing Address - Street 2:SUITE 115
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3606
Mailing Address - Country:US
Mailing Address - Phone:954-866-4223
Mailing Address - Fax:844-635-7210
Practice Address - Street 1:6370 N STATE ROAD 7
Practice Address - Street 2:SUITE 115
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-3606
Practice Address - Country:US
Practice Address - Phone:954-866-4223
Practice Address - Fax:844-635-7210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014041800Medicaid