Healthcare Provider Details

I. General information

NPI: 1235043399
Provider Name (Legal Business Name): TIKKUN DENTAL GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 NE 125TH ST
NORTH MIAMI FL
33161-4717
US

IV. Provider business mailing address

428 NE 125TH ST
NORTH MIAMI FL
33161-4717
US

V. Phone/Fax

Practice location:
  • Phone: 786-600-0494
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANDREW DEMOS
Title or Position: DENTIST
Credential: DMD
Phone: 561-419-3929