NPIMap

Organization Active NPI

Cosmetic & Implant Designs Group PA

  • Dental Clinic/Center
  • Coconut Creek, FL
National Provider Identifier
1457095630
Registry record updated Apr 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
COSMETIC & IMPLANT DESIGNS GROUP PA
Practice address
4825 Coconut Creek Pkwy
Coconut Creek, FL 33063-3944
Phone
(954) 642-2203
NPI assigned
Apr 25, 2022
Last updated
Apr 25, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2022

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

Authorized official

Name
Dr. Johnny Peralta LeeNPI 1396179701
Title
Owner
Phone
(954) 394-9364

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X NU Primary

Addresses

Primary practice location

4825 Coconut Creek Pkwy
Coconut Creek, FL 33063-3944

Mailing address

4825 Coconut Creek Pkwy
Coconut Creek, FL 33063-3944
Phone (954) 642-2203

National Provider Directory

National Provider Directory

Locations

4825 Coconut Creek Pkwy
Coconut Creek, FL 33063
Phone (954) 642-2203

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1650844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650844800000",
    "number": "1457095630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4825 COCONUT CREEK PKWY",
            "city": "COCONUT CREEK",
            "state": "FL",
            "postal_code": "330633944",
            "telephone_number": "954-642-2203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4825 COCONUT CREEK PKWY",
            "city": "COCONUT CREEK",
            "state": "FL",
            "postal_code": "330633944",
            "telephone_number": "954-642-2203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COSMETIC & IMPLANT DESIGNS GROUP PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-25",
        "last_updated": "2022-04-25",
        "certification_date": "2022-04-25",
        "status": "A",
        "authorized_official_last_name": "PERALTA LEE",
        "authorized_official_first_name": "JOHNNY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "954-394-9364",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coconut Creek, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2022; 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.