Philip L Provenzale, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

FL0007396 Issued in FL

Practice address

417 NW 16TH St
Suite 8
Belle Glade, FL 33430-2441

Phone

(561) 996-3700

Fax

(561) 996-9261

NPI assigned

May 3, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Affordable Dentures - Weeki Wachee II, P.a.

  • Dentist
  • Weeki Wachee, FL
  • NPI 1902109309
  NPD (past)
• Affordable Dentures & Implants - Weeki Wachee, P.a.

  • General Practice Dentistry
  • Weeki Wachee, FL
  • NPI 1801628185
  NPD (past)

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1124240908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 249",
            "city": "BELLE GLADE",
            "state": "FL",
            "postal_code": "334300249",
            "telephone_number": "561-996-3700",
            "fax_number": "561-996-9261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 NW 16TH ST",
            "address_2": "SUITE 8",
            "city": "BELLE GLADE",
            "state": "FL",
            "postal_code": "334302441",
            "telephone_number": "561-996-3700",
            "fax_number": "561-996-9261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVENZALE",
        "first_name": "PHILIP",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "FL0007396",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Belle Glade, FL
• Providers in Belle Glade, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.