Indian Trace Dental Associates,P.a.

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

INDIAN TRACE DENTAL ASSOCIATES,P.A.

Doing business as

Indian Trace Dental

Practice address

46 Indian Trce
Weston, FL 33326-4551

Phone

(954) 217-9200

Fax

(954) 217-9500

NPI assigned

Apr 28, 2021

Organization subpart

No

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

Authorized official

Name

Martha Valencia

Title

Office Manager

Phone

(954) 217-9200

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Indian Trace Dental Doing business as

Locations

Practitioners 2

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

• Suncica Martinasevic, D.M.D.

  • Dentist
  • Fort Lauderdale, FL
  • NPI 1720333636
  NPD (past)
• Rodolfo Villa, D.D.S

  • Prosthodontics
  • Weston, FL
  • NPI 1093899171
  NPD (past)

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

{
    "created_epoch": "1619568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619568000000",
    "number": "1780266734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "46 INDIAN TRCE",
            "city": "WESTON",
            "state": "FL",
            "postal_code": "333264551",
            "telephone_number": "954-217-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46 INDIAN TRCE",
            "city": "WESTON",
            "state": "FL",
            "postal_code": "333264551",
            "telephone_number": "954-217-9200",
            "fax_number": "954-217-9500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIAN TRACE DENTAL ASSOCIATES,P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-28",
        "last_updated": "2021-04-28",
        "certification_date": "2021-04-28",
        "status": "A",
        "authorized_official_last_name": "VALENCIA",
        "authorized_official_first_name": "MARTHA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "954-217-9200"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1093899171",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Indian Trace Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Estela M Ibanez Mostajo, BCBA
• Elizabeth Sabrina Ibanez, PH.D.
• Rula M Ibraheem, MD
• Ice Pulmonary Network LLC
• Emily Kathryn Ince
• Seth Infante
• Miriam Janeth Inga Zapata, RD
• Wesley Roland Innocent Jr., LPTA
• Innovative Pediatric Therapy, Inc
• Innovative People Solution

• Dental Clinic/Center in Weston, FL
• Providers in Weston, FL by specialty
• Dental Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2021; 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.