Organization
DENTILIFE FOUR PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CINTHYA FERRADAZ (CREDENTIALING)
(786) 899-1436
Entity
Organization
Contact information
Practice address
5473 N STATE ROAD 7, FORT LAUDERDALE, FL 33319-2954
(954) 486-7025
Mailing address
5473 N STATE ROAD 7, FORT LAUDERDALE, FL 33319-2954
(954) 486-7025
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003823700
—
FL
Enumeration date
09/01/2020
Last updated
09/01/2020
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