# ADVANCED DENTISTRY SOUTH FLORIDA SEPCIALISTS LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** RICHARD J STALLER DDS PA
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1003285339
- **Legal business name:** RICHARD J STALLER DDS PA
- **Authorized official:** KELLI CARTER STALLER (PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (561) 495-2099

## Contact information

- **Practice address:** 15340 JOG RD STE 100, DELRAY BEACH, FL 33446-2170
- **Practice address phone:** (561) 495-2099
- **Mailing address:** 15340 JOG RD STE 100, DELRAY BEACH, FL 33446-2170
- **Mailing address phone:** (561) 495-2099

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | — | NULL | — |
| 1223E0200X | Endodontics | — | — | — |
| 1223P0300X | Periodontics | — | NULL | — |
| 1223P0300X | Periodontics | — | — | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 09/16/2015
- **Last updated:** 09/16/2015