NPIMap

Organization Active NPI

Plantation Dental Associates, PL

  • General Practice Dentistry
  • Plantation, FL
National Provider Identifier
1093806028
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
17136 Issued in FL
Legal business name
PLANTATION DENTAL ASSOCIATES, PL
Practice address
10080 NW 1St CT
Plantation, FL 33324-7035
Phone
(954) 474-8977
Fax
(954) 474-8946
NPI assigned
Sep 27, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Kristin Marie Deedrick
Title
Office Manager
Phone
(954) 474-8977

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 14352 FL
General Practice Dentistry 1223G0001X 10331 FL
General Practice Dentistry 1223G0001X 17136 FL Primary

Addresses

Primary practice location

10080 NW 1St CT
Plantation, FL 33324-7035

Mailing address

10080 NW 1St CT
Plantation, FL 33324-7035
Phone (954) 474-8977

National Provider Directory

National Provider Directory

Locations

10080 NW 1st Ct
Plantation, FL 33324
Phone (954) 474-8977

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1093806028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10080 NW 1ST CT",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333247035",
            "telephone_number": "954-474-8977",
            "fax_number": "954-474-8946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10080 NW 1ST CT",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333247035",
            "telephone_number": "954-474-8977",
            "fax_number": "954-474-8946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLANTATION DENTAL ASSOCIATES, PL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DEEDRICK",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "954-474-8977"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "14352",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "10331",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "17136",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plantation, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.