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General NPI Number Information
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NPI Number | 1235043399
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Entity Type | Organization
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Legal Business Name | TIKKUN DENTAL GROUP PA
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Dates
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Enumeration Date | 09/28/2026
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Last Update Date | 09/28/2026
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Provider Practice Location Address
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Address Line | 428 NE 125TH ST
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City | NORTH MIAMI
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State | FL
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Zip | 33161-4717
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Country | US
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Telephone | 786-600-0494
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Fax |
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Provider Business Mailing Address
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Address Line | 428 NE 125TH ST
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City | NORTH MIAMI
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State | FL
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Zip | 33161-4717
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | ANDREW DEMOS
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Credential | DMD
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Telephone | 561-419-3929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State | NULL
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State | NULL
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State | NULL
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Taxonomy #4
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State | NULL
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