Provider Demographics
NPI:1023250255
Name:DENTALAND, FT PIERCE
Entity type:Organization
Organization Name:DENTALAND, FT PIERCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:FEINGOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-719-4420
Mailing Address - Street 1:3230 W COMMERCIAL BLVD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3429
Mailing Address - Country:US
Mailing Address - Phone:954-719-4420
Mailing Address - Fax:954-678-9539
Practice Address - Street 1:2505 S FEDERAL HWY
Practice Address - Street 2:SABAL PALM PLAZA
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-5922
Practice Address - Country:US
Practice Address - Phone:772-464-4646
Practice Address - Fax:772-460-9967
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTALAND, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN5487122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty