Basic Information
| Provider Information | |||||||||
| NPI: | 1063429348 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHWARTZ | ||||||||
| FirstName: | JUSTIN | ||||||||
| MiddleName: | IVOR | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2226 W ATLANTIC AVE | ||||||||
| Address2: | SUITE W | ||||||||
| City: | DELRAY BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334454637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613308330 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8440 W BROWARD BLVD | ||||||||
| Address2: | |||||||||
| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333242706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544728707 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2006 | ||||||||
| LastUpdateDate: | 07/13/2017 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 06/16/2017 | ||||||||
| NPIReactivationDate: | 07/13/2017 | ||||||||
| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0300X | DN17313 | FL | Y | Dental Providers | Dentist | Periodontics |
No ID Information.