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Organization
COUNTRYSIDE DENTAL ASSOC INC
Active
Organization
COUNTRYSIDE DENTAL ASSOC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL J ANCONA DDS (PRESIDENT/DENTIST)
(954) 434-3229
Entity
Organization
Contact information
Practice address
5810 S. FLAMINGO RD, COOPER CITY, FL 33330-3237
(954) 434-3229
(954) 680-6254
Mailing address
5810 S. FLAMINGO RD, COOPER CITY, FL 33330-3237
(954) 434-3229
(954) 680-6254
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DN18677
FL
122300000X
Dentist
DN8648
FL
122300000X
Dentist
Primary
DN8648
—
1223G0001X
General Practice Dentistry
DN18066
FL
Other
Enumeration date
06/05/2008
Last updated
01/20/2011
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