Provider Demographics
NPI:1700121977
Name:DENTISTRY BY DESIGN, LLC
Entity Type:Organization
Organization Name:DENTISTRY BY DESIGN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAZIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIKARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-932-0995
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33468-0069
Mailing Address - Country:US
Mailing Address - Phone:561-932-0995
Mailing Address - Fax:
Practice Address - Street 1:672 SW PRIMA VISTA BLVD
Practice Address - Street 2:202
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-1820
Practice Address - Country:US
Practice Address - Phone:772-905-2741
Practice Address - Fax:772-336-8266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty