Jose Ricardo Burgos Polo, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

DN27318 Issued in FL

Practice address

37944 Pasco Ave
Dade City, FL 33525-4202

Phone

(352) 518-2000

NPI assigned

Sep 26, 2005

Last updated

Feb 14, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Networks

• Freedom Health HMO Network

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

{
    "created_epoch": "1127692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676332800000",
    "number": "1013903996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 MOLLER WAY",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338132867",
            "telephone_number": "863-660-5401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37944 PASCO AVE",
            "city": "DADE CITY",
            "state": "FL",
            "postal_code": "335254202",
            "telephone_number": "352-518-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6901 State Road 62",
            "address_purpose": "LOCATION",
            "city": "Bowling Green",
            "state": "FL",
            "postal_code": "338348976",
            "country_code": "US",
            "telephone_number": "863-767-3039",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1805 Hobbs Rd",
            "address_2": "Polk County Health Department Auburndale Dental Clinic",
            "address_purpose": "LOCATION",
            "city": "Auburndale",
            "state": "FL",
            "postal_code": "338234644",
            "country_code": "US",
            "telephone_number": "863-965-6333 x10043",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BURGOS POLO",
        "first_name": "JOSE",
        "middle_name": "RICARDO",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-26",
        "last_updated": "2023-02-14",
        "certification_date": "2023-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PR",
            "license": "02586",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN27318",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DTC18",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCS ADVANTAGE",
            "identifier": "660427801F3",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA DENTAL TEMPORARY CERTIFICATE",
            "identifier": "DTC18",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERED MEDICAL CHOICE",
            "identifier": "70338A",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA STATE DENTAL TEMPORARY CERTIFICATE",
            "identifier": "DTC-168",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SSS PROVIDER",
            "identifier": "41079BU",
            "state": "PR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003690900",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INTERNATIONAL MEDICAL CAR",
            "identifier": "7082",
            "state": "PR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dorothy R Budetti, A.R.N.P.
• Emily Buker, OTR
• Kayle Bunce, MS, CCC-SLP
• Kaylee E Buraczewski, RBT
• John S Burby, D.M.D.
• Melissa Maxine Burke, MD
• Jackalynne Burns, MA, BCBA
• Anna Katherine Callahan, APRN
• Rhonda Cameron, PHD
• Alan Carr, DO

• Dentist in Dade City, FL
• Providers in Dade City, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2023; 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.