Active NPI
Izba Mohammad, DMD
- Dentist
- Pembroke Pines, FL
National Provider Identifier
1881304095
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 27217
- Practice address
- 17901 NW 5TH St Ste 206
Pembroke Pines, FL 33029-2810 - Phone
- (954) 430-2188
- NPI assigned
- Nov 29, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 27217 | FL | Primary |
Addresses
Primary practice location
17901 NW 5TH St Ste 206
Pembroke Pines, FL 33029-2810
Mailing address
17352 SW 18TH St
Miramar, FL 33029-5529
Phone (954) 515-7909
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27217 | FL | MD | Dentist |
Networks
- Freedom Health HMO Network
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1669680000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1669680000000",
"number": "1881304095",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17352 SW 18TH ST",
"city": "MIRAMAR",
"state": "FL",
"postal_code": "330295529",
"telephone_number": "954-515-7909"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17901 NW 5TH ST STE 206",
"city": "PEMBROKE PINES",
"state": "FL",
"postal_code": "330292810",
"telephone_number": "954-430-2188"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOHAMMAD",
"first_name": "IZBA",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-11-29",
"last_updated": "2022-11-29",
"certification_date": "2022-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist",
"state": "FL",
"license": "27217",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pembroke Pines, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.