=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780325886
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DEERFIELD BEACH DENTISTRY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2022
-----------------------------------------------------
Last Update Date | 04/05/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1100 S FEDERAL HWY STE 100
-----------------------------------------------------
City | DEERFIELD BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33441-7000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-998-0727
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3003 W YAMATO RD STE C5
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33434-5337
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-998-0727
-----------------------------------------------------
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 | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------