Individual provider Active NPI

Camila Reis Pereira Di Giorgio

  • General Practice Dentistry
  • Pompano Beach, FL
National Provider Identifier
1104292283
Registry record updated Mar 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN23074 Issued in FL
Practice address
1261 S Federal Hwy
Pompano Beach, FL 33062-7070
Phone
(754) 225-1001
Fax
(754) 225-1001
NPI assigned
Aug 12, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DN23074 FL Primary

Addresses

Primary practice location

1261 S Federal Hwy
Pompano Beach, FL 33062-7070

Mailing address

1261 S Federal Hwy
Pompano Beach, FL 33062-7070
Phone (754) 225-1001

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150911001125 KY Practitioner - Dentist 4981910916 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dentist
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Commonwealth of KentuckyGroup PAC ID 0840180816, 28 clinicians

Practice addresses (Care Compare)

4501 Louise Underwood Way
Louisville, KY 40216-3987
Phone 50236823482223

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DN23074FLMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Commonwealth of Kentucky CurrentSince Aug 3, 2015 Accepting new patients
Commonwealth of Kentucky CurrentSince Aug 3, 2015 Accepting new patients
Clear Smiles Holdings LLC General Practice CurrentSince Dec 18, 2022 Accepting new patients
Minty Dental Studio LLC CurrentSince Sep 15, 2019 Accepting new patients

Locations

1261 S Federal Hwy
Pompano Beach, FL 33062
Phone (754) 225-1001

4501 Louise Underwood Way
Louisville, KY 40216
Phone (502) 368-2348

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1439337600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615766400000",
    "number": "1104292283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1261 S FEDERAL HWY",
            "city": "POMPANO BEACH",
            "state": "FL",
            "postal_code": "330627070",
            "telephone_number": "754-225-1001",
            "fax_number": "754-225-1001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1261 S FEDERAL HWY",
            "city": "POMPANO BEACH",
            "state": "FL",
            "postal_code": "330627070",
            "telephone_number": "754-225-1001",
            "fax_number": "754-225-1001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REIS PEREIRA DI GIORGIO",
        "first_name": "CAMILA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-12",
        "last_updated": "2021-03-15",
        "certification_date": "2021-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN23074",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pompano Beach, FL

Sources for this page

Verify at the official NPI Registry.