Organization
COBBLESTONE FAMILY DENTAL, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JORDAN TOMALTY DDS (OWNER)
(561) 633-9676
Entity
Organization
Contact information
Practice address
14938 PINES BLVD, PEMBROKE PINES, FL 33027-1213
(954) 433-2099
Mailing address
14938 PINES BLVD, PEMBROKE PINES, FL 33027-1213
(954) 433-2099
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
DENTAL
—
Enumeration date
06/16/2022
Last updated
06/20/2022
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