1689987026 NPI number — AMERICAN DENTAL OF FLORIDA-MARGATE

Table of content: (NPI 1689987026)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689987026 NPI number — AMERICAN DENTAL OF FLORIDA-MARGATE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN DENTAL OF FLORIDA-MARGATE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689987026
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1509 N STATE ROAD 7
Provider Second Line Business Mailing Address:
SUITE H
Provider Business Mailing Address City Name:
MARGATE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33063-5731
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-974-8550
Provider Business Mailing Address Fax Number:
954-974-1419

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1509 N STATE ROAD 7
Provider Second Line Business Practice Location Address:
SUITE H
Provider Business Practice Location Address City Name:
MARGATE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33063-5731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-974-8550
Provider Business Practice Location Address Fax Number:
954-974-1419
Provider Enumeration Date:
07/14/2010

Additional Information

Authorized Official

Authorized Official Last Name:
KERNS
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER/ DOCTOR
Authorized Official Telephone Number:
954-974-8550

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 109491900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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