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Organization
JUPITER DENTAL GROUP, PA
Active
Organization
JUPITER DENTAL GROUP, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. STEPHANIE GOMEZ (PROVIDER RELATIONS SPECIALIST)
(305) 274-2499
Entity
Organization
Contact information
Practice address
175 TONEY PENNA DR STE 105, JUPITER, FL 33458-5747
(561) 745-3118
Mailing address
13195 SW 134TH ST FL 2, MIAMI, FL 33186-4461
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0300X
Periodontics
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
Other
Enumeration date
02/10/2012
Last updated
08/04/2014
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