Organization
INDIAN TRACE DENTAL ASSOCIATES,P.A.
Active
Other names
Indian Trace Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MARTHA VALENCIA (OFFICE MANAGER)
(954) 217-9200
Entity
Organization
Contact information
Practice address
46 INDIAN TRCE, WESTON, FL 33326-4551
(954) 217-9200
(954) 217-9500
Mailing address
46 INDIAN TRCE, WESTON, FL 33326-4551
(954) 217-9200
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1093899171
NPI
—
Enumeration date
04/28/2021
Last updated
04/28/2021
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