Dynamic Pediatric Dentistry for Children,PLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DN17725 Issued in FL

Legal business name

DYNAMIC PEDIATRIC DENTISTRY FOR CHILDREN,PLC

Practice address

3305 SE Federal Hwy
Stuart, FL 34997-4913

Phone

(772) 221-3112

Fax

(772) 221-3175

NPI assigned

Jun 8, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Cindy Wilson, DDSNPI 1023196797

Title

MMGR

Phone

(772) 221-3112

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Cindy Wilson, DDS

  • Pediatric Dentistry
  • Stuart, FL
  • NPI 1023196797
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1275955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1275955200000",
    "number": "1013237411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3305 SE FEDERAL HWY",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349974913",
            "telephone_number": "772-221-3112",
            "fax_number": "772-221-3175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3305 SE FEDERAL HWY",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349974913",
            "telephone_number": "772-221-3112",
            "fax_number": "772-221-3175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC PEDIATRIC DENTISTRY FOR CHILDREN,PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-08",
        "last_updated": "2010-06-08",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "CINDY",
        "authorized_official_title_or_position": "MMGR",
        "authorized_official_telephone_number": "772-221-3112",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "FL",
            "license": "DN17725",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "076508200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jocelyn Joy Durrant
• Hannah Dutton
• DX Laboratories LLC
• Angela Marie Dyer
• Jo Ellen Dyer, LCSW
• Dynamikids Inc
• Dynamix Chiropractic LLC
• E & N Companion Care LLC
• Jennifer Eagle, CNM, ARNP
• Earl E. Griffith, PH.D.

• Pediatric Dentistry in Stuart, FL
• Providers in Stuart, FL by specialty
• Pediatric Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.