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AB DENTRISTY INC
Complete NPI Record 1164759817
Clinic/Center - Dental in Doral, FL

NPI Status: Active since November 17, 2009

Contact Information

10750 NW 66TH ST APT 509
DORAL, FL
ZIP 33178
Phone: (305) 807-6872

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Business Mailing Address City Name
  7. Provider Business Mailing Address State Name
  8. Provider Business Mailing Address Postal Code
  9. Provider Business Mailing Address Country Code If outside U S
  10. Provider Business Mailing Address Telephone Number
  11. Provider First Line Business Practice Location Address
  12. Provider Business Practice Location Address City Name
  13. Provider Business Practice Location Address State Name
  14. Provider Business Practice Location Address Postal Code
  15. Provider Business Practice Location Address Country Code If outside U S
  16. Provider Business Practice Location Address Telephone Number
  17. Provider Enumeration Date
  18. Last Update Date
  19. Authorized Official Last Name
  20. Authorized Official First Name
  21. Authorized Official Middle Name
  22. Authorized Official Title or Position
  23. Authorized Official Telephone Number
  24. Healthcare Provider Taxonomy Code 1
  25. Healthcare Provider Primary Taxonomy Switch 1
  26. Is Organization Subpart
  27. Authorized Official Name Prefix Text
  28. Authorized Official Credential Text

Complete NPI Dataset

This page represents the complete record for NPI 1164759817. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1164759817
The last name of the provider. If the provider is an individual, this is the legal name.
Entity Type Code: 2
The first name of the provider, if the provider is an individual.
Employer Identification Number EIN: UNAVAIL
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address: 10750 NW 66TH ST APT 509
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address City Name: DORAL
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: FL
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 331783775
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 3058076872
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider First Line Business Practice Location Address: 10750 NW 66TH ST APT 509
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Practice Location Address City Name: DORAL
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: FL
The city name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code: 331783775
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number: 3058076872
The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date: 11/17/2009
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 8/9/2010
The date that a record was last updated or changed.
Authorized Official Last Name: BETANCOURT
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: ARELY
The first name of the authorized official.
Authorized Official Middle Name: MARIA
The middle name of the authorized official.
Authorized Official Title or Position: PRESIDENT
The title or position of the authorized official.
Authorized Official Telephone Number: 3058076872
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 261QD0000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: Y
Is Organization Subpart: N
Authorized Official Name Prefix Text: DR.
Authorized Official Credential Text: DDS