Healthcare Provider Details

I. General information

NPI: 1013759539
Provider Name (Legal Business Name): ISLAND PARADISE DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2024
Last Update Date: 06/07/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260-A GREAT CRUZ BAY PALM PLAZA UNIT 1-A
CRUZ BAY VI
00831
US

IV. Provider business mailing address

PO BOX 8326
ST JOHN VI
00831-8326
US

V. Phone/Fax

Practice location:
  • Phone: 340-693-8898
  • Fax:
Mailing address:
  • Phone: 340-693-8898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RAMESH KIANFAR
Title or Position: PRESIDENT
Credential: DMD
Phone: 201-724-0600