South Dental at Sunny Isles Beach Inc.

Primary specialty

DentistTaxonomy code 122300000X

License

DN14672 Issued in FL

Legal business name

SOUTH DENTAL AT SUNNY ISLES BEACH INC.

Practice address

16850 Collins Ave Ste 113C
Sunny Isles Beach, FL 33160-4237

Phone

(786) 707-4757

NPI assigned

Oct 17, 2016

Organization subpart

No

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

Authorized official

Name

Elias Tobon-Angel, DMD

Title

Owner

Phone

(786) 224-0848

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1476662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476662400000",
    "number": "1285185090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16850 COLLINS AVE STE 113C",
            "city": "SUNNY ISLES BEACH",
            "state": "FL",
            "postal_code": "331604237",
            "telephone_number": "786-707-4757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16850 COLLINS AVE STE 113C",
            "city": "SUNNY ISLES BEACH",
            "state": "FL",
            "postal_code": "331604237",
            "telephone_number": "786-707-4757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH DENTAL AT SUNNY ISLES BEACH INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-17",
        "last_updated": "2016-10-17",
        "status": "A",
        "authorized_official_last_name": "TOBON-ANGEL",
        "authorized_official_first_name": "ELIAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "786-224-0848",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN14672",
            "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 Oct 17, 2016; 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.