Active NPI
Beeta Akhavan
- Dentist
- Port St Lucie, FL
National Provider Identifier
1063072767
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN24140
- Practice address
- 1722 SW Saint Lucie West Blvd
Port St Lucie, FL 34986-2504 - Phone
- (772) 337-8600
- NPI assigned
- Jun 17, 2019
- Last updated
- Jun 17, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN24140 | FL | Primary |
Addresses
Primary practice location
1722 SW Saint Lucie West Blvd
Port St Lucie, FL 34986-2504
Mailing address
2050 Chatsworth Way
Tallahassee, FL 32309-2966
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN24140 | FL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sage Dental of Port St Lucie West, PLLC | Dentist | Past | Accepting new patients |
Networks
- Freedom Health HMO Network
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Dentist
- Port St Lucie, FL
- NPI 1205193539
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1560729600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560729600000",
"number": "1063072767",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2050 CHATSWORTH WAY",
"city": "TALLAHASSEE",
"state": "FL",
"postal_code": "323092966"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1722 SW SAINT LUCIE WEST BLVD",
"city": "PORT ST LUCIE",
"state": "FL",
"postal_code": "349862504",
"telephone_number": "772-337-8600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AKHAVAN",
"first_name": "BEETA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-06-17",
"last_updated": "2019-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "DN24140",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port St Lucie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.