Provider Demographics
NPI:1356618474
Name:ACADEMIA DENTAL PA
Entity type:Organization
Organization Name:ACADEMIA DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TASKONAK
Authorized Official - Middle Name:
Authorized Official - Last Name:BURAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-792-5001
Mailing Address - Street 1:17395 N BAY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-3334
Mailing Address - Country:US
Mailing Address - Phone:305-792-5001
Mailing Address - Fax:305-792-5007
Practice Address - Street 1:17395 N BAY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SUNNY ISLES BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-3334
Practice Address - Country:US
Practice Address - Phone:305-792-5001
Practice Address - Fax:305-792-5007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN184521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty