NPIMap

Organization Active NPI

Periodontal Associates of Tampa Bay, P.a.

  • Periodontics
  • Temple Terrace, FL
National Provider Identifier
1053606178
Registry record updated Jun 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
DN16867 Issued in FL
Legal business name
PERIODONTAL ASSOCIATES OF TAMPA BAY, P.A.
Practice address
5208 E Fowler Ave Ste F
Temple Terrace, FL 33617-2152
Phone
(813) 988-1103
Fax
(813) 985-1524
NPI assigned
Jun 16, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2011

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

Authorized official

Name
Dr. Brian Todd Vanaelst, D.M.D
Title
Periodontist
Phone
(813) 988-1103

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0300X DN16867 FL Primary

Addresses

Primary practice location

5208 E Fowler Ave Ste F
Temple Terrace, FL 33617-2152

Mailing address

5208 E Fowler Ave Ste F
Temple Terrace, FL 33617-2152
Phone (813) 988-1103

National Provider Directory

National Provider Directory

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": "1308182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308182400000",
    "number": "1053606178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5208 E FOWLER AVE STE F",
            "city": "TEMPLE TERRACE",
            "state": "FL",
            "postal_code": "336172152",
            "telephone_number": "813-988-1103",
            "fax_number": "813-985-1524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5208 E FOWLER AVE STE F",
            "city": "TEMPLE TERRACE",
            "state": "FL",
            "postal_code": "336172152",
            "telephone_number": "813-988-1103",
            "fax_number": "813-985-1524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERIODONTAL ASSOCIATES OF TAMPA BAY, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-16",
        "last_updated": "2011-06-16",
        "status": "A",
        "authorized_official_last_name": "VANAELST",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "TODD",
        "authorized_official_title_or_position": "PERIODONTIST",
        "authorized_official_telephone_number": "813-988-1103",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "FL",
            "license": "DN16867",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Temple Terrace, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 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.