Destination Dental Group PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

DESTINATION DENTAL GROUP PC

Practice address

2455 E Sunrise Blvd Ste 1204
Fort Lauderdale, FL 33304-3115

Phone

(616) 299-2692

NPI assigned

Jan 22, 2025

Organization subpart

No

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

Authorized official

Name

Dan Kelsey

Title

Cfo

Phone

(616) 299-2692

Specialties & licenses 1

Addresses

Other names 1

• Destination Dental Other name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Daniel Belotserkovsky, DDS

  • General Practice Dentistry
  • St Augustine, FL
  • NPI 1912344904
  NPD

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

{
    "created_epoch": "1737504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737504000000",
    "number": "1316759905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2455 E SUNRISE BLVD STE 1204",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333043115",
            "telephone_number": "616-299-2692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2455 E SUNRISE BLVD STE 1204",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333043115",
            "telephone_number": "616-299-2692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESTINATION DENTAL GROUP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-22",
        "last_updated": "2025-01-22",
        "certification_date": "2025-01-22",
        "status": "A",
        "authorized_official_last_name": "KELSEY",
        "authorized_official_first_name": "DAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "616-299-2692"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Destination Dental",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Donna Lynn Desmarais, LMHC
• Cheryl Marie Desmidt, MS LMFT
• Jennifer Desruisseaux
• Shadaina Dessalines, DNP, APRN, FNP-BC
• Ellan Destinasse, BS, CBHCM
• Destination Hope
• Destination Hope, Inc.
• Detox Centers of America LLC
• Arvind Kumar Dev
• Venu G Devabhaktuni, M.D.

• General Practice Dentistry in Fort Lauderdale, FL
• Providers in Fort Lauderdale, 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 Jan 22, 2025; 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.