Countryside Dental Assoc Inc

Primary specialty

DentistTaxonomy code 122300000X

License

DN8648

Legal business name

COUNTRYSIDE DENTAL ASSOC INC

Practice address

5810 S. Flamingo Rd
Cooper City, FL 33330-3237

Phone

(954) 434-3229

Fax

(954) 680-6254

NPI assigned

Jun 5, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Michael J Ancona, DDS

Title

President/Dentist

Phone

(954) 434-3229

Specialties & licenses 4

Addresses

Locations

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

{
    "created_epoch": "1212624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295481600000",
    "number": "1699934646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5810 S. FLAMINGO RD",
            "city": "COOPER CITY",
            "state": "FL",
            "postal_code": "333303237",
            "telephone_number": "954-434-3229",
            "fax_number": "954-680-6254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5810 S. FLAMINGO RD",
            "city": "COOPER CITY",
            "state": "FL",
            "postal_code": "333303237",
            "telephone_number": "954-434-3229",
            "fax_number": "954-680-6254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRYSIDE DENTAL ASSOC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-05",
        "last_updated": "2011-01-20",
        "status": "A",
        "authorized_official_last_name": "ANCONA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT/DENTIST",
        "authorized_official_telephone_number": "954-434-3229",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN8648",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": "DN8648",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN18677",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN18066",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Marjan Cvetkovic, DPT, PT

• Dentist in Cooper City, FL
• Providers in Cooper City, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2011; 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.