Individual provider Active NPI

Miriannys Fiffe Gonzalez

  • General Practice Dentistry
  • Boynton Beach, FL
National Provider Identifier
1356038798
Registry record updated Jul 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN28405 Issued in FL
Practice address
8773 Boynton Beach Blvd Unit 520
Boynton Beach, FL 33472-4481
Phone
(561) 200-2904
NPI assigned
Apr 18, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
General Practice Dentistry 1223G0001X DN28405 FL Primary

Addresses

Primary practice location

8773 Boynton Beach Blvd Unit 520
Boynton Beach, FL 33472-4481

Mailing address

8773 Boynton Beach Blvd Unit 520
Boynton Beach, FL 33472-4481
Phone (561) 200-2904

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

LicenseStateTypeSpecialty
DN28405FLMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Boynton Beach Modern Dentistry, PA PastSince Jul 16, 2023 Accepting new patients

Networks

  • Freedom Health HMO Network

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1681776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689206400000",
    "number": "1356038798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8773 BOYNTON BEACH BLVD UNIT 520",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334724481",
            "telephone_number": "561-200-2904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8773 BOYNTON BEACH BLVD UNIT 520",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334724481",
            "telephone_number": "561-200-2904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FIFFE GONZALEZ",
        "first_name": "MIRIANNYS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-18",
        "last_updated": "2023-07-13",
        "certification_date": "2023-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN28405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boynton Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2023; 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.