Active NPI
Afsoon Elmore, DDS
- Dentist
- Fern Park, FL
National Provider Identifier
1013962893
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 16958
- Practice address
- 2715 Lakeview Dr
Fern Park, FL 32730-2005 - Phone
- (407) 260-0669
- Fax
- (407) 629-0031
- NPI assigned
- May 23, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 16958 | FL | Primary |
Addresses
Primary practice location
2715 Lakeview Dr
Fern Park, FL 32730-2005
Mailing address
2715 Lakeview Dr
Fern Park, FL 32730-2005
Phone (407) 260-0669
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 075545100 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16958 | FL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148342400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1013962893",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2715 LAKEVIEW DR",
"city": "FERN PARK",
"state": "FL",
"postal_code": "327302005",
"telephone_number": "407-260-0669",
"fax_number": "407-629-0031"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2715 LAKEVIEW DR",
"city": "FERN PARK",
"state": "FL",
"postal_code": "327302005",
"telephone_number": "407-260-0669",
"fax_number": "407-629-0031"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELMORE",
"first_name": "AFSOON",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-05-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "16958",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "075545100",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fern Park, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.