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Organization
PEMBROKE DENTAL ASSOCIATES
Active
Organization
PEMBROKE DENTAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDGAR J PORRAS DDS (PRESIDENT)
(954) 432-7077
Entity
Organization
Contact information
Practice address
12251 TAFT ST, SUITE 404, PEMBROKE PINES, FL 33026-1901
(954) 432-7077
(954) 433-0748
Mailing address
12251 TAFT ST, SUITE 404, PEMBROKE PINES, FL 33026-1901
(954) 432-7077
(954) 433-0748
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
DN11671
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001313400
—
FL
Enumeration date
02/10/2012
Last updated
02/10/2012
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