Provider Demographics
NPI:1710798426
Name:KIDS CARE DENTAL AND ORTHODONTICS OF EAST COMMERCIAL, INC
Entity type:Organization
Organization Name:KIDS CARE DENTAL AND ORTHODONTICS OF EAST COMMERCIAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NIGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANDISON
Authorized Official - Suffix:
Authorized Official - Credentials:DMS
Authorized Official - Phone:954-326-2947
Mailing Address - Street 1:10794 PINES BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-3920
Mailing Address - Country:US
Mailing Address - Phone:954-632-8171
Mailing Address - Fax:954-432-6716
Practice Address - Street 1:2633 E COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4135
Practice Address - Country:US
Practice Address - Phone:954-632-8171
Practice Address - Fax:954-432-6716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty