NPIMap

Organization Active NPI

Mount Dora Dental & Dentures

  • Dentist
  • Mount Dora, FL
National Provider Identifier
1033372958
Registry record updated Feb 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
14970 Issued in FL
Legal business name
MOUNT DORA DENTAL & DENTURES
Practice address
2781 W Old Highway 441
#24A
Mount Dora, FL 32757
Phone
(352) 385-1971
Fax
(352) 729-2239
NPI assigned
Jul 10, 2008
Organization subpart
Yes
Parent organization
MOUNT DORA DENTAL & DENTURESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 22, 2011

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

Authorized official

Name
Dr. Sook Ja Kim, D.M.D
Title
Owner
Phone
(352) 385-1971

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 14970 FL Primary

Addresses

Primary practice location

2781 W Old Highway 441
#24A
Mount Dora, FL 32757

Mailing address

2781 W Old Highway 441
#24A
Mount Dora, FL 32757
Phone (352) 385-1971

Other identifiers 1

IdentifierTypeStateIssuer
002879200MedicaidFL

Other names 1

  • Affordable Dental Care Doing business as

National Provider Directory

National Provider Directory
Part of
Mount Dora Dental Dentures

Locations

2781 W Old 441
#24A
Mount Dora, FL 32757
Phone (352) 385-1971

Practitioners & affiliated clinicians

Practitioners 1

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": "1215648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1298332800000",
    "number": "1033372958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2781 W OLD HIGHWAY 441",
            "address_2": "#24A",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "32757",
            "telephone_number": "352-385-1971",
            "fax_number": "325-729-2239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2781 W OLD HIGHWAY 441",
            "address_2": "#24A",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "32757",
            "telephone_number": "352-385-1971",
            "fax_number": "352-729-2239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNT DORA DENTAL & DENTURES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOUNT DORA DENTAL & DENTURES",
        "enumeration_date": "2008-07-10",
        "last_updated": "2011-02-22",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "SOOK",
        "authorized_official_middle_name": "JA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "352-385-1971",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "14970",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002879200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Affordable Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Dora, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2011; 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.