NPIMap

Organization Active NPI

Pettissheparddentastic LLC

Doing business as Dentastic Dental Center

  • Dentist
  • Pompano Beach, FL
National Provider Identifier
1467839522
Registry record updated Apr 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN7571 Issued in FL
Legal business name
PETTISSHEPARDDENTASTIC LLC
Doing business as
Dentastic Dental Center
Practice address
2747 E Atlantic Blvd
Pompano Beach, FL 33062-4941
Phone
(954) 781-4670
NPI assigned
Apr 28, 2015
Last updated
Apr 28, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2015

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

Authorized official

Name
Mr. Paul R Shepard, PA
Title
Manager
Phone
(954) 781-4670

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DN19680 FL
Dentist 122300000X DN19879 FL
Dentist 122300000X DN7571 FL Primary

Addresses

Primary practice location

2747 E Atlantic Blvd
Pompano Beach, FL 33062-4941

Mailing address

2747 E Atlantic Blvd
Pompano Beach, FL 33062-4941
Phone (954) 781-4670

Other names 1

  • Dentastic Dental Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dentastic Dental Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2747 E Atlantic Blvd
Pompano Beach, FL 33062
Phone (954) 781-4323

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": "1430179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430179200000",
    "number": "1467839522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2747 E ATLANTIC BLVD",
            "city": "POMPANO BEACH",
            "state": "FL",
            "postal_code": "330624941",
            "telephone_number": "954-781-4670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2747 E ATLANTIC BLVD",
            "city": "POMPANO BEACH",
            "state": "FL",
            "postal_code": "330624941",
            "telephone_number": "954-781-4670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETTISSHEPARDDENTASTIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-28",
        "last_updated": "2015-04-28",
        "status": "A",
        "authorized_official_last_name": "SHEPARD",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "954-781-4670",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN19680",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN19879",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN7571",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dentastic Dental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pompano Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2015; 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.