South Dental Doral, Spa, Inc

Primary specialty

DentistTaxonomy code 122300000X

License

13563 Issued in FL

Legal business name

SOUTH DENTAL DORAL, SPA, INC

Practice address

3655 NW 107TH Ave
Suite 103
Doral, FL 33178-4327

Phone

(305) 388-7599

Fax

(305) 388-1315

NPI assigned

Jul 2, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Jahn Oppenheimer, DDS

Title

Owner

Phone

(305) 388-7599

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1214956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214956800000",
    "number": "1164685996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3655 NW 107TH AVE",
            "address_2": "SUITE 103",
            "city": "DORAL",
            "state": "FL",
            "postal_code": "331784327",
            "telephone_number": "305-388-7599",
            "fax_number": "305-388-1315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3655 NW 107TH AVE",
            "address_2": "SUITE 103",
            "city": "DORAL",
            "state": "FL",
            "postal_code": "331784327",
            "telephone_number": "305-388-7599",
            "fax_number": "305-388-1315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH DENTAL DORAL, SPA, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-02",
        "last_updated": "2008-07-02",
        "status": "A",
        "authorized_official_last_name": "OPPENHEIMER",
        "authorized_official_first_name": "JAHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "305-388-7599",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "13563",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2008; 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.