NPIMap

Organization Active NPI

Southpark Dental Group

  • Dentist
  • Orlando, FL
National Provider Identifier
1093815029
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
14090 Issued in FL
Legal business name
SOUTHPARK DENTAL GROUP
Practice address
8801 Commodity Cir
Orlando, FL 32819-9053
Phone
(407) 248-0100
Fax
(407) 248-8364
NPI assigned
Sep 22, 2006
Last updated
Sep 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Dr. John F Cervenka, D.D.S.NPI 1598868614
Title
Owner
Phone
(407) 248-0100

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 6

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 14090 FL Primary
General Practice Dentistry 1223G0001X 9168 FL
General Practice Dentistry 1223G0001X 13762 FL
General Practice Dentistry 1223G0001X 14238 FL
General Practice Dentistry 1223G0001X 16360 FL
Periodontics 1223P0300X 12525 FL

Addresses

Primary practice location

8801 Commodity Cir
Orlando, FL 32819-9053

Mailing address

8801 Commodity Cir
Orlando, FL 32819-9053
Phone (407) 248-0100

Other identifiers 1

IdentifierTypeStateIssuer
836729OtherUNITED CONCORDIA

National Provider Directory

National Provider Directory

Locations

8801 Commodity Cir
Orlando, FL 32819
Phone (407) 248-0100

Practitioners & affiliated clinicians

Practitioners 7

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": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1093815029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8801 COMMODITY CIR",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328199053",
            "telephone_number": "407-248-0100",
            "fax_number": "407-248-8364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8801 COMMODITY CIR",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328199053",
            "telephone_number": "407-248-0100",
            "fax_number": "407-248-8364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHPARK DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "CERVENKA",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "407-248-0100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "14090",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "9168",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "13762",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "14238",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "16360",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "FL",
            "license": "12525",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "836729",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.