Provider Demographics
NPI:1558932608
Name:IMPLANTATION DENTISTRY
Entity Type:Organization
Organization Name:IMPLANTATION DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EHAB
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSHARBASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-652-5119
Mailing Address - Street 1:1761 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-4111
Mailing Address - Country:US
Mailing Address - Phone:954-990-5657
Mailing Address - Fax:954-990-5689
Practice Address - Street 1:1761 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-4111
Practice Address - Country:US
Practice Address - Phone:954-990-5657
Practice Address - Fax:954-990-5689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicaid