=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487456430
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | POMPANO BEACH DENTISTRY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2025
-----------------------------------------------------
Last Update Date | 03/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2231 NE 25TH AVE STE 4
-----------------------------------------------------
City | POMPANO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33062-1148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-782-7911
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3003 W YAMATO RD STE C5
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33434-5337
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-457-3690
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | NAVED FATMI
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 786-457-3690
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------