Provider Demographics
NPI:1164924494
Name:YADEGARI ORTHODONTICS LLC
Entity Type:Organization
Organization Name:YADEGARI ORTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:VEDAD
Authorized Official - Last Name:YADEGARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-521-7981
Mailing Address - Street 1:12741 MIRAMAR PKWY STE 203
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-2905
Mailing Address - Country:US
Mailing Address - Phone:954-236-5273
Mailing Address - Fax:
Practice Address - Street 1:12741 MIRAMAR PKWY STE 203
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-2905
Practice Address - Country:US
Practice Address - Phone:954-236-5273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-02
Last Update Date:2021-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN230961223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL700436Medicaid