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JACARANDA SMILES WEST NPI 1295269116


NPI Information

NPI: 1295269116
Provider Name: JACARANDA SMILES WEST
Classification: Dentist - 1223P0221X
Entity Type: Organization

Specialization: Pediatric Dentistry

Address:
18503 PINES BLVD
SUITE 209
PEMBROKE PINES, FL
ZIP 33029
Phone: (954) 436-0502
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JACARANDA SMILES WEST is a pediatric dentistry dentist in Pembroke Pines, FL. The provider is an age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. JACARANDA SMILES WEST NPI is 1295269116. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

18503 PINES BLVD
SUITE 209
PEMBROKE PINES, FL
ZIP 33029-404
Phone: (954) 436-0502
Fax: (954) 436-0503

The provider's authorized official is Milan Khakhria .
The authorized official title is Owner and has the following contact phone number (954) 436-0502.

The enumeration date for this NPI number is 4/18/2017 and was last updated on 4/18/2017.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
11223P0221XDentistPediatric DentistryYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1003557500MEDICAIDFLORIDA

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

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.