Atm Amin DDS LLC

Primary specialty

DentistTaxonomy code 122300000X

License

10430 Issued in FL

Legal business name

ATM AMIN DDS LLC

Practice address

4620 Lipscomb St NE
Suite 2
Palm Bay, FL 32905

Phone

(321) 724-5100

Fax

(321) 724-5139

NPI assigned

Feb 2, 2012

Organization subpart

No

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

Authorized official

Name

Atm Nurul Amin

Title

Owner

Phone

(321) 724-5100

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1328140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328140800000",
    "number": "1265704548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4620 LIPSCOMB ST NE",
            "address_2": "SUITE 2",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "32905",
            "telephone_number": "321-724-5100",
            "fax_number": "321-724-5139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4620 LIPSCOMB ST NE",
            "address_2": "SUITE 2",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "32905",
            "telephone_number": "321-724-5100",
            "fax_number": "321-724-5139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATM AMIN DDS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-02",
        "last_updated": "2012-02-02",
        "status": "A",
        "authorized_official_last_name": "AMIN",
        "authorized_official_first_name": "ATM",
        "authorized_official_middle_name": "NURUL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "321-724-5100"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "10430",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "077777300",
            "state": "FL"
        }
    ],
    "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 2, 2012; 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.