Mohammad Abdollahzadehfard
Individual provider Active NPI Dentist · Fort Lauderdale, FL
NPI 1417634320 · NPPES record last updated Jul 31, 2023
Key facts
- NPI
- 1417634320
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 28385 (FL)
- Practice address
- 1865 Cordova Rd
Fort Lauderdale, FL 33316-2198 - Phone
- (954) 947-1458
- NPI assigned
- Jul 3, 2023
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230930000199 | FL | Order and Referring Only - Dentist |
1456705029 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28385 | FL | MD | Dentist |
Practice roles (1 of 2)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dentists of Fort Lauderdale, PA | Dentist | Past |
Accepting new patients |
Networks
- Freedom Health HMO Network
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 28385 | FL | Yes |
Addresses
Primary practice location
1865 Cordova Rd
Fort Lauderdale, FL 33316-2198
Mailing address
1 SW 94TH Ter
Plantation, FL 33324-2429
Other providers in Fort Lauderdale, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 31, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.