Excellent Dental PA

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

EXCELLENT DENTAL PA

Practice address

1507 N John Young Pkwy Ste B
Kissimmee, FL 34741-3214

Phone

(949) 305-2253

NPI assigned

Mar 28, 2022

Organization subpart

No

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

Authorized official

Name

Jared Woolf

Title

President

Phone

(949) 305-2253

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1648425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648425600000",
    "number": "1104576487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 ARGONAUT STE 220",
            "city": "ALISO VIEJO",
            "state": "CA",
            "postal_code": "926564105",
            "telephone_number": "949-305-2253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1507 N JOHN YOUNG PKWY STE B",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347413214",
            "telephone_number": "949-305-2253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCELLENT DENTAL PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-28",
        "last_updated": "2022-03-28",
        "certification_date": "2022-03-28",
        "status": "A",
        "authorized_official_last_name": "WOOLF",
        "authorized_official_first_name": "JARED",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "949-305-2253"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2022; 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.