Summit Dental Center, PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN0014412 Issued in FL

Legal business name

SUMMIT DENTAL CENTER, PA

Practice address

3913 N Andrews Ave
Oakland Park, FL 33309-5239

Phone

(954) 561-6675

Fax

(954) 630-2017

NPI assigned

Nov 3, 2006

Organization subpart

No

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

Authorized official

Name

Jean R Elysee, DDS

Title

Director

Phone

(954) 561-6675

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202256000000",
    "number": "1255410742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3913 N ANDREWS AVE",
            "city": "OAKLAND PARK",
            "state": "FL",
            "postal_code": "333095239",
            "telephone_number": "954-561-6675",
            "fax_number": "954-630-2017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3913 N ANDREWS AVE",
            "city": "OAKLAND PARK",
            "state": "FL",
            "postal_code": "333095239",
            "telephone_number": "954-561-6675",
            "fax_number": "954-630-2017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT DENTAL CENTER, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-03",
        "last_updated": "2008-02-06",
        "status": "A",
        "authorized_official_last_name": "ELYSEE",
        "authorized_official_first_name": "JEAN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "954-561-6675",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN0014412",
            "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 Feb 6, 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.