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Organization
INDIAN TRACE DENTAL ASSOCIATES,P.A.
Active
Organization
INDIAN TRACE DENTAL ASSOCIATES,P.A.
Active
Other names
Indian Trace Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MARTHA VALENCIA (OFFICE MANAGER)
(954) 217-9200
Entity
Organization
Contact information
Practice address
46 INDIAN TRCE, WESTON, FL 33326-4551
(954) 217-9200
(954) 217-9500
Mailing address
46 INDIAN TRCE, WESTON, FL 33326-4551
(954) 217-9200
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1093899171
NPI
—
Enumeration date
04/28/2021
Last updated
04/28/2021
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