NPIMap

Organization Active NPI

Alkhadra DDS, P.a.

  • Pediatric Dentistry
  • Fort Lauderdale, FL
National Provider Identifier
1194050690
Registry record updated Jun 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
DN16650 Issued in FL
Legal business name
ALKHADRA DDS, P.A.
Practice address
4800 NE 20TH Ter Ste 301
Fort Lauderdale, FL 33308-4510
Phone
(954) 727-9865
Fax
(954) 727-9904
NPI assigned
Oct 16, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2010

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

Authorized official

Name
Enas Alkhadra, DDSNPI 1588672430
Title
Owner
Phone
(561) 212-0715

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X DN16650 FL Primary

Addresses

Primary practice location

4800 NE 20TH Ter Ste 301
Fort Lauderdale, FL 33308-4510

Mailing address

4800 NE 20TH Ter Ste 301
Fort Lauderdale, FL 33308-4510
Phone (954) 727-9865

Other identifiers 1

IdentifierTypeStateIssuer
075773000MedicaidFL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1255651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277769600000",
    "number": "1194050690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 NE 20TH TER STE 301",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333084510",
            "telephone_number": "954-727-9865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 NE 20TH TER STE 301",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333084510",
            "telephone_number": "954-727-9865",
            "fax_number": "954-727-9904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALKHADRA DDS, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-16",
        "last_updated": "2010-06-29",
        "status": "A",
        "authorized_official_last_name": "ALKHADRA",
        "authorized_official_first_name": "ENAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "561-212-0715",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "FL",
            "license": "DN16650",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "075773000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Lauderdale, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2010; 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.