Healthcare Provider Details

I. General information

NPI: 1588218143
Provider Name (Legal Business Name): NIRANJAN JOSHI BDS, MDS, CERT. PROS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2019
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 S UNIVERSITY DR
DAVIE FL
33328-2018
US

IV. Provider business mailing address

2098 MADEIRA DR
WESTON FL
33327-1917
US

V. Phone/Fax

Practice location:
  • Phone: 954-262-7213
  • Fax:
Mailing address:
  • Phone: 918-413-7207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberF-016
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDTP763
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: