International Smile Institute PA

Primary specialty

DentistTaxonomy code 122300000X

License

DN16553 Issued in FL

Legal business name

INTERNATIONAL SMILE INSTITUTE PA

Practice address

2161 E Commercial Blvd
3Rd Floor
Fort Lauderdale, FL 33308

Phone

(954) 772-0842

Fax

(954) 776-7480

NPI assigned

Jul 24, 2008

Organization subpart

No

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

Authorized official

Name

Stuart Michael Goff, DDS

Title

Dentist President

Phone

(954) 772-0842

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1216857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216857600000",
    "number": "1043475437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2161 E COMMERCIAL BLVD",
            "address_2": "3RD FLOOR",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "33308",
            "telephone_number": "954-772-0842",
            "fax_number": "954-776-7480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2161 E COMMERCIAL BLVD",
            "address_2": "3RD FLOOR",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "33308",
            "telephone_number": "954-772-0842",
            "fax_number": "954-776-7480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNATIONAL SMILE INSTITUTE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-24",
        "last_updated": "2008-07-24",
        "status": "A",
        "authorized_official_last_name": "GOFF",
        "authorized_official_first_name": "STUART",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "DENTIST PRESIDENT",
        "authorized_official_telephone_number": "954-772-0842",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN16553",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2008; 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.