Organization
ADVANCED DENTISTRY SOUTH FLORIDA SEPCIALISTS LLC
Active
Parent organization
RICHARD J STALLER DDS PA
Organization subpart
Yes
Provider details
NPI number
Legal business name
RICHARD J STALLER DDS PA
Authorized official
KELLI CARTER STALLER (PRACTICE ADMINISTRATOR)
(561) 495-2099
Entity
Organization
Contact information
Practice address
15340 JOG RD STE 100, DELRAY BEACH, FL 33446-2170
(561) 495-2099
Mailing address
15340 JOG RD STE 100, DELRAY BEACH, FL 33446-2170
(561) 495-2099
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
—
—
1223P0300X
Periodontics
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
09/16/2015
Last updated
09/16/2015
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