NPIMap

Organization Active NPI

Dentists of Port Charlotte, PA

  • Dentist
  • Port Charlotte, FL
National Provider Identifier
1013558154
Registry record updated Oct 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
DENTISTS OF PORT CHARLOTTE, PA
Practice address
1720 Tamiami TRL Ste 102
Port Charlotte, FL 33948-1121
Phone
(941) 584-8926
Fax
(941) 702-9407
NPI assigned
Sep 30, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2019

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

Authorized official

Name
Dr. Minh B Pham, DDS
Title
Owner
Phone
(941) 584-8926

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

1720 Tamiami TRL Ste 102
Port Charlotte, FL 33948-1121

Mailing address

17000 Red Hill Ave
Irvine, CA 92614-5626
Phone (714) 845-8500

Other names 1

  • Dentists of Port Charlotte Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dentists of Port Charlotte2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1720 Tamiami Trl
Ste 102
Port Charlotte, FL 33948
Phone (941) 584-8926

Practitioners & affiliated clinicians

Practitioners 12

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

NPI Registry JSON

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

{
    "created_epoch": "1569801600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571097600000",
    "number": "1013558154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17000 RED HILL AVE",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926145626",
            "telephone_number": "714-845-8500",
            "fax_number": "303-952-0892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 TAMIAMI TRL STE 102",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339481121",
            "telephone_number": "941-584-8926",
            "fax_number": "941-702-9407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTISTS OF PORT CHARLOTTE, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-30",
        "last_updated": "2019-10-15",
        "status": "A",
        "authorized_official_last_name": "PHAM",
        "authorized_official_first_name": "MINH",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "941-584-8926",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dentists of Port Charlotte",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Charlotte, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2019; 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.