NPIMap

Organization Active NPI

Progressive Orthodontics, PLLC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Bartow, FL
National Provider Identifier
1083945711
Registry record updated Jan 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
DN10745 Issued in FL
Legal business name
PROGRESSIVE ORTHODONTICS, PLLC
Practice address
2110 E. Flamingo Dr.
Bartow, FL 33830-4236
Phone
(863) 533-3302
Fax
(863) 534-3818
NPI assigned
Jan 20, 2010
Last updated
Jan 20, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
PROGRESSIVE ORTHODONTICS, PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 20, 2010

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

Authorized official

Name
Dr. Timothy M. Ellis, DMD, MS, PANPI 1588767040
Title
Patner/Owner
Phone
(863) 533-3302

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X DN16931 FL
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X DN10745 FL Primary

Addresses

Primary practice location

2110 E. Flamingo Dr.
Bartow, FL 33830-4236

Mailing address

2110 E. Flamingo Dr.
Bartow, FL 33830-4236
Phone (863) 533-3302

National Provider Directory

National Provider Directory
Part of
Progressive Orthodontics PLLC

Locations

2110 Flamingo Dr
Bartow, FL 33830
Phone (863) 533-3302

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1263945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263945600000",
    "number": "1083945711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2110 E. FLAMINGO DR.",
            "city": "BARTOW",
            "state": "FL",
            "postal_code": "338304236",
            "telephone_number": "863-533-3302",
            "fax_number": "863-534-3818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2110 E. FLAMINGO DR.",
            "city": "BARTOW",
            "state": "FL",
            "postal_code": "338304236",
            "telephone_number": "863-533-3302",
            "fax_number": "863-534-3818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROGRESSIVE ORTHODONTICS, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROGRESSIVE ORTHODONTICS, PLLC",
        "enumeration_date": "2010-01-20",
        "last_updated": "2010-01-20",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "PATNER/OWNER",
        "authorized_official_telephone_number": "863-533-3302",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD, MS, PA"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "FL",
            "license": "DN16931",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "FL",
            "license": "DN10745",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bartow, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2010; 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.