Organization
LAKE WORTH FAMILY DENTISTRY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ILYA STEIN D.M.D. (PRESIDENT)
(555) 555-5555
Entity
Organization
Contact information
Practice address
6427 LAKE WORTH RD STE 102, GREENACRES, FL 33463-2900
(561) 649-6446
Mailing address
10800 AVENIDA DEL RIO, DELRAY BEACH, FL 33446-2444
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN14972
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
070167000
—
FL
Enumeration date
09/22/2008
Last updated
09/22/2008
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