Mikaela Benlulu, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

103748 Issued in CA

Practice address

2623 S Seacrest Blvd Ste 112
Boynton Beach, FL 33435-7531

Phone

(561) 810-8790

NPI assigned

Mar 6, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Mrs. Mikaela Goodman Former name

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• Freedom Health HMO Network

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Genesis Community Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Boynton Beach, FL
  • NPI 1447578125
  Medicare reassignment NPD
• Genesis Community Health Inc

  • Federally Qualified Health Center (FQHC)
  • Boca Raton, FL
  • NPI 1073982831
  NPD

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

{
    "created_epoch": "1488758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717027200000",
    "number": "1295275642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "639 E OCEAN AVE STE 409",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334355017",
            "telephone_number": "561-735-6553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2623 S SEACREST BLVD STE 112",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334357531",
            "telephone_number": "561-810-8790"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9193 Sierra Ave Ste A",
            "address_purpose": "LOCATION",
            "city": "Fontana",
            "state": "CA",
            "postal_code": "923354776",
            "country_code": "US",
            "telephone_number": "909-365-3565",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1100 N State St",
            "address_2": "Clinic Tower A3C",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900335000",
            "country_code": "US",
            "telephone_number": "323-409-5014",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BENLULU",
        "first_name": "MIKAELA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-03-06",
        "last_updated": "2024-05-30",
        "certification_date": "2024-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "103748",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MIKAELA",
            "last_name": "GOODMAN",
            "prefix": "MRS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ann Bendgen, M.S.
• Benezon LLC
• Moshe Bengio, DO
• Ian S. Benison, D.C.
• Nixalyz Ortiz Benitez, FNP - BC
• Carly Victoria Bennett, MS CCC-SLP
• Steve Benson, CRNA
• Rebekah Lynn Benters, PTA
• Bentin Chiropractic Wellness Ctr,PLLC
• Delbert August Benzenhafer III, M.D.

• General Practice Dentistry in Boynton Beach, FL
• Providers in Boynton Beach, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.