Organization
GLO AESTHETIC & LASER INSTITUTE LLC
Active
Organization
GLO AESTHETIC & LASER INSTITUTE LLC
Active
Other names
Boca VIP Dermatology & Laser Institute
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK ALAN DANTON DO (MEDICAL DIRECTOR)
(561) 704-4565
Entity
Organization
Contact information
Practice address
7100 W CAMINO REAL, SUITE 206, BOCA RATON, FL 33433-5510
(561) 704-4565
(561) 368-2264
Mailing address
7945 PALACIO DEL MAR DR, BOCA RATON, FL 33433-4149
(561) 704-4565
(561) 368-2264
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
OS6841
FL
207Q00000X
Family Medicine Physician
OS6841
FL
Other
Enumeration date
03/31/2008
Last updated
12/03/2008
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