Provider Demographics
NPI:1255362877
Name:PHANORD & ASSOCIATES PA
Entity type:Organization
Organization Name:PHANORD & ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:J
Authorized Official - Last Name:PHANOD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-685-7863
Mailing Address - Street 1:1245 NW 119 ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33167
Mailing Address - Country:US
Mailing Address - Phone:305-685-7863
Mailing Address - Fax:305-687-7603
Practice Address - Street 1:1245 NW 119 ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33167
Practice Address - Country:US
Practice Address - Phone:305-685-7863
Practice Address - Fax:305-687-7603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00148091223P0221X
FLDN00112361223S0112X
FLDN00113391223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Not Answered1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty