NPIMap

Organization Active NPI

Miramar Modern Dentistry, PA

  • General Practice Dentistry
  • Miramar, FL
National Provider Identifier
1821667684
Registry record updated Jun 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MIRAMAR MODERN DENTISTRY, PA
Practice address
12621 Miramar Pkwy Bay 102
Miramar, FL 33027-2910
Phone
(954) 621-1496
Fax
(954) 666-6199
NPI assigned
Jun 24, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2021

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

Authorized official

Name
Minh Pham, DDS
Title
Owner
Phone
(954) 621-1496

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

12621 Miramar Pkwy Bay 102
Miramar, FL 33027-2910

Mailing address

PO Box 920050
Dallas, TX 75392-0050
Phone (714) 845-8890

National Provider Directory

National Provider Directory

Locations

12621 Miramar Pkwy
#102
Miramar, FL 33027
Phone (954) 621-1496

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1624492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624579200000",
    "number": "1821667684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 920050",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753920050",
            "telephone_number": "714-845-8890",
            "fax_number": "303-952-0892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12621 MIRAMAR PKWY BAY 102",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330272910",
            "telephone_number": "954-621-1496",
            "fax_number": "954-666-6199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIRAMAR MODERN DENTISTRY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-24",
        "last_updated": "2021-06-25",
        "certification_date": "2021-06-25",
        "status": "A",
        "authorized_official_last_name": "PHAM",
        "authorized_official_first_name": "MINH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "954-621-1496",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Miramar, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 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.