# LAKE WORTH FAMILY DENTISTRY, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689824153
- **Authorized official:** DR. ILYA STEIN D.M.D. (PRESIDENT)
- **Authorized official phone:** (555) 555-5555

## Contact information

- **Practice address:** 6427 LAKE WORTH RD STE 102, GREENACRES, FL 33463-2900
- **Practice address phone:** (561) 649-6446
- **Mailing address:** 10800 AVENIDA DEL RIO, DELRAY BEACH, FL 33446-2444

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DN14972 | FL | Yes |

## Other

- **Enumeration date:** 09/22/2008
- **Last updated:** 09/22/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 070167000 | — | FL |