NPIMap

Organization Active NPI

Homestead Modern Dentistry, PA

Doing business as Homestead Modern Dentistry

  • Dentist
  • Homestead, FL
National Provider Identifier
1235777855
Registry record updated May 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
HOMESTEAD MODERN DENTISTRY, PA
Doing business as
Homestead Modern Dentistry
Practice address
805 N Homestead Blvd
Homestead, FL 33030-5024
Phone
(786) 410-6656
NPI assigned
Dec 13, 2019
Last updated
May 11, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2022

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

Authorized official

Name
Dr. Cynthia Bustillo, DMD
Title
Owner
Phone
(786) 410-6656

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

805 N Homestead Blvd
Homestead, FL 33030-5024

Mailing address

PO Box 920050
Dallas, TX 75392-0050

Other names 1

  • Homestead Modern Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

805 N Homestead Blvd
Homestead, FL 33030
Phone (786) 410-6656

Practitioners & affiliated clinicians

Practitioners 4

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": "1576195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652227200000",
    "number": "1235777855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 920050",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753920050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 N HOMESTEAD BLVD",
            "city": "HOMESTEAD",
            "state": "FL",
            "postal_code": "330305024",
            "telephone_number": "786-410-6656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOMESTEAD MODERN DENTISTRY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-13",
        "last_updated": "2022-05-11",
        "certification_date": "2022-05-11",
        "status": "A",
        "authorized_official_last_name": "BUSTILLO",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "786-410-6656",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Homestead Modern Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Homestead Modern Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 May 11, 2022; 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.