Organization
ADVANCED DENTAL WELLNESS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BORIS LIPOVETSKIY (OWNER)
(954) 525-5662
Entity
Organization
Contact information
Practice address
104 SE 1ST ST, FORT LAUDERDALE, FL 33301-1924
(954) 525-5662
(954) 525-5251
Mailing address
104 SE 1ST ST, FORT LAUDERDALE, FL 33301-1924
(954) 525-5662
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN21039
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1629113808
GROUP NPI
FL
Enumeration date
12/07/2017
Last updated
12/07/2017
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