Active NPI
Mithun Suresh, DDS
- Endodontics
- Homestead, FL
National Provider Identifier
1083096234
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- DN26707
- Practice address
- 925 NE 30TH Ter Ste 114
Homestead, FL 33033-7614 - Phone
- (301) 502-2586
- NPI assigned
- Jun 24, 2015
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | DN26707 | FL | Primary |
Addresses
Primary practice location
925 NE 30TH Ter Ste 114
Homestead, FL 33033-7614
Mailing address
1100 Brickell Bay Dr
Miami, FL 33131-3539
Phone (301) 502-2586
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230707000000 | FL | Order and Referring Only - Dentist | 9830558972 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1435104000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706486400000",
"number": "1083096234",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1100 BRICKELL BAY DR",
"city": "MIAMI",
"state": "FL",
"postal_code": "331313539",
"telephone_number": "301-502-2586"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "925 NE 30TH TER STE 114",
"city": "HOMESTEAD",
"state": "FL",
"postal_code": "330337614",
"telephone_number": "301-502-2586"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SURESH",
"first_name": "MITHUN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-06-24",
"last_updated": "2024-01-29",
"certification_date": "2024-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "FL",
"license": "DN26707",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Homestead, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.