Individual provider Active NPI

Anthony H Bezerra, D.D.S.

  • General Practice Dentistry
  • Davie, FL
National Provider Identifier
1972800852
Registry record updated Jan 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
546 Issued in FL
Practice address
3200 S University Dr
Davie, FL 33328-2018
Phone
(954) 262-7369
Fax
(954) 262-2689
NPI assigned
Feb 11, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 546 FL
General Practice Dentistry 1223G0001X 546 FL Primary

Addresses

Primary practice location

3200 S University Dr
Davie, FL 33328-2018

Mailing address

PO Box 290370
Ft Lauderdale, FL 33329-0370
Phone (954) 262-4346

Other names 1

  • Dr. Antonio Herbete Paz Bezerra Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170301001379 FL Practitioner - Oral Surgery 1850675372 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
546FLMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Nova Southeastern University Inc. CurrentSince Jan 6, 2017 Accepting new patients
Nova Southeastern University, Inc Current Accepting new patients
Nova Southeastern University, Inc. CurrentSince Jan 6, 2017 Accepting new patients
Nova Southeastern University, Inc PastSince Jul 16, 2023 Accepting new patients
Nova Southeastern University, Inc Past Accepting new patients

Locations

3200 S University Dr
Bldg 2ND
Davie, FL 33328
Phone (954) 262-4200

3200 S University Dr
Davie, FL 33328
Phone (954) 262-1250

650 N Andrews Ave
Ft Lauderdale, FL 33311
Phone (954) 463-4213

1750 NE 167th St
North Miami Beach, FL 33162
Phone (305) 949-4000

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1297382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1483660800000",
    "number": "1972800852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 290370",
            "city": "FT LAUDERDALE",
            "state": "FL",
            "postal_code": "333290370",
            "telephone_number": "954-262-4346",
            "fax_number": "954-262-2269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 S UNIVERSITY DR",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333282018",
            "telephone_number": "954-262-7369",
            "fax_number": "954-262-2689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEZERRA",
        "first_name": "ANTHONY",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-02-11",
        "last_updated": "2017-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "546",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "546",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANTONIO",
            "last_name": "BEZERRA",
            "middle_name": "HERBETE PAZ",
            "prefix": "DR.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Davie, FL

Sources for this page

Verify at the official NPI Registry.