Provider Demographics
NPI:1902553357
Name:FAMILY DENTISTRY OF JENSEN BEACH PLLC
Entity Type:Organization
Organization Name:FAMILY DENTISTRY OF JENSEN BEACH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMALTY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-789-6611
Mailing Address - Street 1:8794 W BOYNTON BEACH BLVD STE 218
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33472-4469
Mailing Address - Country:US
Mailing Address - Phone:561-789-6611
Mailing Address - Fax:
Practice Address - Street 1:3571 NW FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-4454
Practice Address - Country:US
Practice Address - Phone:772-444-0601
Practice Address - Fax:772-444-3371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-06
Last Update Date:2022-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental