Healthcare Provider Details

I. General information

NPI: 1508432428
Provider Name (Legal Business Name): MICHAEL SOFIANOS JR. DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 45TH ST STE 100
WEST PALM BEACH FL
33407-2416
US

IV. Provider business mailing address

1515 N FLAGLER DR STE 101
WEST PALM BEACH FL
33401-3429
US

V. Phone/Fax

Practice location:
  • Phone: 561-642-1000
  • Fax:
Mailing address:
  • Phone: 561-833-9469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDN25857
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: