John Tawadrous, DMD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DN22323 Issued in FL

Practice address

501 N Orlando Ave Ste 233
Winter Park, FL 32789-2947

Phone

(407) 792-0637

NPI assigned

Sep 15, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Main Street Children'S Dentistry and Orthodontics of Winter Park, PA

  • Pediatric Dentistry
  • Winter Park, FL
  • NPI 1306138045
  NPD (past)

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

{
    "created_epoch": "1473897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598832000000",
    "number": "1043768328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4930 E. LAKE MARY BLVD.",
            "city": "SANFORD",
            "state": "FL",
            "postal_code": "32771",
            "telephone_number": "407-322-8645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 N ORLANDO AVE STE 233",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327892947",
            "telephone_number": "407-792-0637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAWADROUS",
        "first_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-09-15",
        "last_updated": "2020-08-31",
        "certification_date": "2020-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN22323",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "FL",
            "license": "DN22323",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "021314900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Manuela Tart
• Petunia Tarver, M. ED.
• Sadie Monet Tate, LM, CPM
• John M. Tatum, M.D.
• Leslie Taveras
• Amy Garten Taylor, PA-C
• Chantel Amena Taylor, MD
• Kaleb Taylor, MS
• Taylor Taylor, MSN, APRN, CNM
• Taylors Pharmacy LLC

• Pediatric Dentistry in Winter Park, FL
• Providers in Winter Park, FL by specialty
• Pediatric Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2020; 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.