Nova Dental Inc

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN15793 Issued in FL

Legal business name

NOVA DENTAL INC

Practice address

1501 SE 23Rd Ave
Pompano Beach, FL 33062-7507

Phone

(954) 825-9128

NPI assigned

May 12, 2016

Organization subpart

No

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

Authorized official

Name

Santiago Roldan, DMD

Title

Owner

Phone

(954) 825-9128

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1463011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463011200000",
    "number": "1730535345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 SE 23RD AVE",
            "city": "POMPANO BEACH",
            "state": "FL",
            "postal_code": "330627507",
            "telephone_number": "954-825-9128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 SE 23RD AVE",
            "city": "POMPANO BEACH",
            "state": "FL",
            "postal_code": "330627507",
            "telephone_number": "954-825-9128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVA DENTAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-12",
        "last_updated": "2016-05-12",
        "status": "A",
        "authorized_official_last_name": "ROLDAN",
        "authorized_official_first_name": "SANTIAGO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "954-825-9128",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN15793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2016; 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.