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Organization
1500 DENTAL LLC
Active
Organization
1500 DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NEKELDA A WEISS CDA, DPMA (INSURANCE & CREDENTIALING COORDINAT)
(954) 715-1000
Entity
Organization
Contact information
Practice address
1500 N FEDERAL HWY STE 250, FORT LAUDERDALE, FL 33304-5603
(954) 715-1000
(954) 372-1000
Mailing address
1500 N FEDERAL HWY STE 250, FORT LAUDERDALE, FL 33304-5603
(954) 715-1000
(954) 372-1000
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DN14284
FL
1223P0300X
Periodontics
Primary
DN16336
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1043392111
NPI
FL
01
—
1407978679
NPI
FL
Enumeration date
05/03/2018
Last updated
05/03/2018
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