Provider Demographics
NPI:1730539115
Name:DESMONDEZ, DANTE ADRIAN
Entity type:Individual
Prefix:
First Name:DANTE
Middle Name:ADRIAN
Last Name:DESMONDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 ALCAZAR ST
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-1201
Mailing Address - Country:US
Mailing Address - Phone:910-494-0358
Mailing Address - Fax:
Practice Address - Street 1:160 ALCAZAR ST
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-1201
Practice Address - Country:US
Practice Address - Phone:910-494-0358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26610174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist