Provider Demographics
NPI:1902143530
Name:HOLLYWOOD DENTAL CARE
Entity Type:Organization
Organization Name:HOLLYWOOD DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:GANGI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-367-5671
Mailing Address - Street 1:2303 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE 14
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-6711
Mailing Address - Country:US
Mailing Address - Phone:954-367-5671
Mailing Address - Fax:954-653-1326
Practice Address - Street 1:2303 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 14
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-6711
Practice Address - Country:US
Practice Address - Phone:954-367-5671
Practice Address - Fax:954-653-1326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-16
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN38841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty