Active NPI
Michael Goffredo, D.M.D.
- Dentist
- Boca Raton, FL
National Provider Identifier
1306848429
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN8005
- Practice address
- 23082 Sandalfoot Plaza Dr
Boca Raton, FL 33428-6654 - Phone
- (561) 482-4111
- Fax
- (561) 482-4211
- NPI assigned
- Jun 1, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN8005 | FL | Primary |
Addresses
Primary practice location
23082 Sandalfoot Plaza Dr
Boca Raton, FL 33428-6654
Mailing address
21017 Shady Vista LN
Boca Raton, FL 33428-1185
Phone (561) 483-5171
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN8005 | FL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1117584000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1267574400000",
"number": "1306848429",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21017 SHADY VISTA LN",
"city": "BOCA RATON",
"state": "FL",
"postal_code": "334281185",
"telephone_number": "561-483-5171"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23082 SANDALFOOT PLAZA DR",
"city": "BOCA RATON",
"state": "FL",
"postal_code": "334286654",
"telephone_number": "561-482-4111",
"fax_number": "561-482-4211"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOFFREDO",
"first_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-06-01",
"last_updated": "2010-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "DN8005",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.