Lake Butler Dental Group PA

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

LAKE BUTLER DENTAL GROUP PA

Practice address

4014 Winter Garden Vineland Road
Suite B
Winter Garden, FL 34787

Phone

(321) 248-2923

Fax

(321) 418-8920

NPI assigned

Jan 10, 2023

Organization subpart

No

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

Authorized official

Name

Minh Pham, DDS

Title

Owner

Phone

(321) 248-2923

Specialties & licenses 1

Addresses

Other names 1

• LAKE BUTLER DENTAL GROUP Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Grant Casto, DDS

  • General Practice Dentistry
  • Port Saint Lucie, FL
  • NPI 1881312965
  NPD
• Maryana Zaverukha, DMD

  • Dentist
  • Orlando, FL
  • NPI 1578356192
  NPD

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

{
    "created_epoch": "1673308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673308800000",
    "number": "1124732698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 920050",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753920050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4014 WINTER GARDEN VINELAND ROAD",
            "address_2": "SUITE B",
            "city": "WINTER GARDEN",
            "state": "FL",
            "postal_code": "34787",
            "telephone_number": "321-248-2923",
            "fax_number": "321-418-8920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE BUTLER DENTAL GROUP PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-10",
        "last_updated": "2023-01-10",
        "certification_date": "2023-01-06",
        "status": "A",
        "authorized_official_last_name": "PHAM",
        "authorized_official_first_name": "MINH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "321-248-2923",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LAKE BUTLER DENTAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kristine Terry PHD PLLC
• Paul L Kujda, RPH
• Sajo Kurian, PA-C
• Shakera Labadie, BT, RBT, BACB
• Alexis Laduke
• Lakeshore Rheumatology, PLLC
• Taina Laloi, RCSWI
• David Chad Lamoreaux, M.D.
• Joan Lampkin, MA
• Raymond Gregory Lande, DO

• Dental Clinic/Center in Winter Garden, FL
• Providers in Winter Garden, FL by specialty
• Dental Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2023; 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.