Provider Demographics
NPI:1235205493
Name:JOSEPH KILSHTOK DDS PA
Entity Type:Organization
Organization Name:JOSEPH KILSHTOK DDS PA
Other - Org Name:PORT OF MIAMI DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:KILSHTOK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-933-9634
Mailing Address - Street 1:2100 E HALLANDALE BCH BLVD
Mailing Address - Street 2:#304
Mailing Address - City:HALLANDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33009
Mailing Address - Country:US
Mailing Address - Phone:954-456-2100
Mailing Address - Fax:954-457-9141
Practice Address - Street 1:1015 N AMERICA WY
Practice Address - Street 2:#150
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132
Practice Address - Country:US
Practice Address - Phone:305-530-0706
Practice Address - Fax:305-358-5440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLDN107741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTIN