Organization
FAMILY DENTISTRY COSMETIC DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MANON BOURQUE HUTCHISON (OWNER)
(954) 570-8870
Entity
Organization
Contact information
Practice address
5359 LYONS RD, COCONUT CREEK, FL 33073-2825
(954) 570-8870
(954) 571-6736
Mailing address
5359 LYONS RD, COCONUT CREEK, FL 33073-2825
(954) 570-8870
(954) 571-6736
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN13436
FL
122300000X
Dentist
DN5044
FL
1223E0200X
Endodontics
DN19185
FL
1223P0300X
Periodontics
DN0011990
FL
124Q00000X
Dental Hygienist
DH15026
FL
Other
Enumeration date
06/22/2016
Last updated
06/22/2016
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