Daniela Modesto Gran Dental Inc.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN17097 Issued in FL

Legal business name

DANIELA MODESTO GRAN DENTAL INC.

Practice address

2500 E Commercial Blvd
Suite E
Fort Lauderdale, FL 33308-4124

Phone

(954) 662-7447

NPI assigned

Apr 3, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Daniela Modesto, DDS

Title

Dentist/President

Phone

(954) 554-3490

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1364947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364947200000",
    "number": "1730422247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 PARKVIEW DR APT 720",
            "city": "HALLANDALE BEACH",
            "state": "FL",
            "postal_code": "330092932",
            "telephone_number": "954-554-3490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 E COMMERCIAL BLVD",
            "address_2": "SUITE E",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333084124",
            "telephone_number": "954-662-7447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DANIELA MODESTO GRAN DENTAL INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-03",
        "last_updated": "2013-04-03",
        "status": "A",
        "authorized_official_last_name": "MODESTO",
        "authorized_official_first_name": "DANIELA",
        "authorized_official_title_or_position": "DENTIST/PRESIDENT",
        "authorized_official_telephone_number": "954-554-3490",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN 17097",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN17097",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Fort Lauderdale, FL
• Providers in Fort Lauderdale, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2013; 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.