Advanced Dental Wellness Center

Primary specialty

DentistTaxonomy code 122300000X

License

DN21039 Issued in FL

Legal business name

ADVANCED DENTAL WELLNESS CENTER

Practice address

104 SE 1St St
Fort Lauderdale, FL 33301-1924

Phone

(954) 525-5662

Fax

(954) 525-5251

NPI assigned

Dec 7, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Boris LipovetskiyNPI 1629113808

Title

Owner

Phone

(954) 525-5662

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Boris Lipovetskiy, DMD

  • General Practice Dentistry
  • Fort Lauderdale, FL
  • NPI 1629113808
  NPD Authorized official
• Nadja A Horst, D.M.D., P.A.

  • Dentist
  • Fort Lauderdale, FL
  • NPI 1811314131
  NPD (past)

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

{
    "created_epoch": "1512604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512604800000",
    "number": "1730694191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 SE 1ST ST",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333011924",
            "telephone_number": "954-525-5662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 SE 1ST ST",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333011924",
            "telephone_number": "954-525-5662",
            "fax_number": "954-525-5251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DENTAL WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-07",
        "last_updated": "2017-12-07",
        "status": "A",
        "authorized_official_last_name": "LIPOVETSKIY",
        "authorized_official_first_name": "BORIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "954-525-5662",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN21039",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1629113808",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Fort Lauderdale, FL
• Providers in Fort Lauderdale, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2017; 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.