Dental Specialists of Pembroke Pines Group

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN5838 Issued in FL

Legal business name

DENTAL SPECIALISTS OF PEMBROKE PINES GROUP

Practice address

12558 Pines Blvd
Pembroke Pines, FL 33027-1713

Phone

(305) 220-8911

NPI assigned

Aug 24, 2017

Last updated

Aug 24, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Ivan Pelton, DDS

Title

Clinical Director

Phone

(305) 220-8911

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1503532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1503532800000",
    "number": "1073030755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12558 PINES BLVD",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330271713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12558 PINES BLVD",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330271713",
            "telephone_number": "305-220-8911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL SPECIALISTS OF PEMBROKE PINES GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-24",
        "last_updated": "2017-08-24",
        "status": "A",
        "authorized_official_last_name": "PELTON",
        "authorized_official_first_name": "IVAN",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "305-220-8911",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN5838",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dental Bliss P.a. (Angelic Smiles Dental Spa)
• Dental Boost Pines, LLC (Dental Boost, LLC)
• Dental Choice Mobile Florida LLC
• Dental Implant 24HRS Pembroke Pines LLC (Dr. Implant)
• Dental Smile LLC
• Dentists of Pines, PA (Dentists of Pines)
• Dermatology Group of Florida PA
• Anup Desai, FNP-C
• Shreena Jatin Desai, DO
• Nelson Descamps, RBT

• 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 Aug 24, 2017; 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.