Healthcare Provider Details

I. General information

NPI: 1255362877
Provider Name (Legal Business Name): PHANORD & ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 NW 119 ST
MIAMI FL
33167
US

IV. Provider business mailing address

1245 NW 119 ST
MIAMI FL
33167
US

V. Phone/Fax

Practice location:
  • Phone: 305-685-7863
  • Fax: 305-687-7603
Mailing address:
  • Phone: 305-685-7863
  • Fax: 305-687-7603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN0011339
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN0014809
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN0011236
License Number StateFL

VIII. Authorized Official

Name: DR. ROGER J PHANOD
Title or Position: OWNER AND DOCTOR
Credential: DMD
Phone: 305-685-7863