PEMBROKE DENTAL ASSOCIATES NPI 1154694891

NPI Information

NPI: 1154694891
Provider Name: PEMBROKE DENTAL ASSOCIATES
Classification: Dentist - 1223E0200X
Entity Type: Organization

Specialization: Endodontics

Address:
12251 TAFT ST
SUITE 404
PEMBROKE PINES, FL
ZIP 33026
Phone: (954) 432-7077
Get Directions

PEMBROKE DENTAL ASSOCIATES is an endodontics dentist in Pembroke Pines, FL. The provider is the branch of dentistry that is concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic and clinical sciences including biology of the normal pulp, the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions. PEMBROKE DENTAL ASSOCIATES NPI is 1154694891. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

12251 TAFT ST
SUITE 404
PEMBROKE PINES, FL
ZIP 33026-901
Phone: (954) 432-7077
Fax: (954) 433-0748

The provider's authorized official is Edgar J Porras .
The authorized official title is President and has the following contact phone number (954) 432-7077.

The enumeration date for this NPI number is 2/10/2012 and was last updated on 2/10/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	1223E0200X	Dentist	Endodontics	DN11671	FLORIDA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	001313400	MEDICAID	FLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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