Organization
BOULEVARD CENTER FOR ADVANCED DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEROME VITALE DMD (DENTIST/OWNER)
(772) 337-1111
Entity
Organization
Contact information
Practice address
1343 SE PORT ST LUCIE BLVD, PORT ST LUCIE, FL 34952-5366
(772) 337-1111
Mailing address
1343 SE PORT ST LUCIE BLVD, PORT ST LUCIE, FL 34952-5366
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DN13975
FL
Other
Enumeration date
11/12/2015
Last updated
11/12/2015
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