Premier Dental Group of Hallandale

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

PREMIER DENTAL GROUP OF HALLANDALE

Practice address

1701 E Hallandale Beach Blvd
Hallandale Beach, FL 33009-4621

Phone

(954) 458-4584

Fax

(954) 458-4078

NPI assigned

Sep 17, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Carlos Maza

Title

Ceo

Phone

(954) 458-4584

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1347840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347840000000",
    "number": "1013267145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 EAST HALLANDLE BEACH BLVD",
            "city": "HALLANDALE",
            "state": "FL",
            "postal_code": "330094621",
            "telephone_number": "954-458-4584",
            "fax_number": "954-458-4078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 E HALLANDALE BEACH BLVD",
            "city": "HALLANDALE BEACH",
            "state": "FL",
            "postal_code": "330094621",
            "telephone_number": "954-458-4584",
            "fax_number": "954-458-4078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER DENTAL GROUP OF HALLANDALE",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-17",
        "last_updated": "2012-09-17",
        "status": "A",
        "authorized_official_last_name": "MAZA",
        "authorized_official_first_name": "CARLOS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "954-458-4584"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Hallandale Beach, FL
• Providers in Hallandale Beach, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.