Provider Demographics
NPI:1780118273
Name:FAMILY & COSMETIC DENTISTRY AMD
Entity type:Organization
Organization Name:FAMILY & COSMETIC DENTISTRY AMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANATOLY
Authorized Official - Middle Name:
Authorized Official - Last Name:RIPA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-615-5722
Mailing Address - Street 1:1048 KANE CONCOURSE
Mailing Address - Street 2:FAMILY & COSMETIC DENTISTRY
Mailing Address - City:BAY HARBOR ISLANDS
Mailing Address - State:FL
Mailing Address - Zip Code:33154
Mailing Address - Country:US
Mailing Address - Phone:305-615-5722
Mailing Address - Fax:954-900-1635
Practice Address - Street 1:1048 KANE CONCOURSE
Practice Address - Street 2:FAMILY & COSMETIC DENTISTRY
Practice Address - City:BAY HARBOR ISLANDS
Practice Address - State:FL
Practice Address - Zip Code:33154-2132
Practice Address - Country:US
Practice Address - Phone:305-615-5722
Practice Address - Fax:954-900-1635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty