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HERON BAY DENTAL ASSOCIATES, P.A.

Company Details

Entity Name: HERON BAY DENTAL ASSOCIATES, P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 23 Mar 2000 (25 years ago)
Document Number: P00000029612
FEI/EIN Number 651013029
Address: 5960 CORAL RIDGE DRIVE, CORAL SPRINGS, FL, 33076
Mail Address: 5960 CORAL RIDGE DRIVE, CORAL SPRINGS, FL, 33076
ZIP code: 33076
County: Broward
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1487872230 2007-04-24 2020-08-22 5960 CORAL RIDGE DR, CORAL SPRINGS, FL, 330763302, US 5960 CORAL RIDGE DR, CORAL SPRINGS, FL, 330763302, US

Contacts

Phone +1 954-255-5550
Fax 9547558276

Authorized person

Name DR. KEITH MARLOWE FRIEFELD
Role PRESIDENT
Phone 9542555550

Taxonomy

Taxonomy Code 1223G0001X - General Practice Dentistry
License Number DN11976
State FL
Is Primary Yes

Agent

Name Role Address
FRIEFELD SHELDON Agent 7533 HAWKS LANDING DRIVE, WEST PALM BEACH, FL, 33412

Director

Name Role Address
FRIEFELD KEITH M Director 16843 Pavilion Way, Delray Beach, FL, 33446

Date of last update: 01 Jan 2025

Sources: Florida Department of State