Healthcare Provider Details

I. General information

NPI: 1700121977
Provider Name (Legal Business Name): DENTISTRY BY DESIGN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2012
Last Update Date: 11/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

672 SW PRIMA VISTA BLVD 202
PORT ST LUCIE FL
34983-1820
US

IV. Provider business mailing address

PO BOX 69
JUPITER FL
33468-0069
US

V. Phone/Fax

Practice location:
  • Phone: 772-905-2741
  • Fax: 772-336-8266
Mailing address:
  • Phone: 561-932-0995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. MAZIN SHIKARA
Title or Position: OWNER
Credential: M.D.
Phone: 561-932-0995