Lakes Mall Dental Center , PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

19377 Issued in FL

Legal business name

LAKES MALL DENTAL CENTER , PA

Practice address

11401 Pines Blvd Ste 220
Pembroke Pines, FL 33026-4104

Phone

(954) 432-5515

NPI assigned

Dec 4, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Erik O Calderon, D.M.D

Title

President

Phone

(305) 951-9988

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1354579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354579200000",
    "number": "1063757912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1830 S OCEAN DR APT 2204",
            "city": "HALLANDALE BEACH",
            "state": "FL",
            "postal_code": "330097695",
            "telephone_number": "305-951-9988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11401 PINES BLVD STE 220",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330264104",
            "telephone_number": "954-432-5515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKES MALL DENTAL CENTER , PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-04",
        "last_updated": "2012-12-04",
        "status": "A",
        "authorized_official_last_name": "CALDERON",
        "authorized_official_first_name": "ERIK",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "305-951-9988",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "19377",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tania Lahera Sanchez, APRN
• Charmaine P Laing, MD
• Navid Lajevardi, DMD
• Lidie Lajoie, M.D.
• Lakes Mall Dental
• Lakeside Med LLC
• Lakeside Medical and Aesthetic Centre LC
• Lakeside Medical LLC
• Habeeb Ali Lakhani, M.D.
• Lakou Medical Consulting LLC

• General Practice Dentistry in Pembroke Pines, FL
• Providers in Pembroke Pines, 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 Dec 4, 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.