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Organization
PETTISSHEPARDDENTASTIC LLC
Active
Organization
PETTISSHEPARDDENTASTIC LLC
Active
Other names
Dentastic Dental Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL R SHEPARD PA (MANAGER)
(954) 781-4670
Entity
Organization
Contact information
Practice address
2747 E ATLANTIC BLVD, POMPANO BEACH, FL 33062-4941
(954) 781-4670
Mailing address
2747 E ATLANTIC BLVD, POMPANO BEACH, FL 33062-4941
(954) 781-4670
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DN19680
FL
122300000X
Dentist
DN19879
FL
122300000X
Dentist
Primary
DN7571
FL
Other
Enumeration date
04/28/2015
Last updated
04/28/2015
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