Carillon Cosmetic & General Dentistry

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

16089 Issued in FL

Legal business name

CARILLON COSMETIC & GENERAL DENTISTRY

Practice address

13180 Livingston Rd BLDG 100
Suite # 106
Naples, FL 34109-3871

Phone

(239) 263-0912

Fax

(239) 263-0925

NPI assigned

Jan 5, 2016

Organization subpart

No

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

Authorized official

Name

Victor Vergara, DMD

Title

Owner - Operating Dentist

Phone

(239) 595-0821

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1451952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1451952000000",
    "number": "1134585334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13180 LIVINGSTON RD BLDG 100",
            "address_2": "SUITE # 106",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341093871",
            "telephone_number": "239-263-0912",
            "fax_number": "239-263-0925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13180 LIVINGSTON RD BLDG 100",
            "address_2": "SUITE # 106",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341093871",
            "telephone_number": "239-263-0912",
            "fax_number": "239-263-0925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARILLON COSMETIC & GENERAL DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-05",
        "last_updated": "2016-01-05",
        "status": "A",
        "authorized_official_last_name": "VERGARA",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_title_or_position": "OWNER - OPERATING DENTIST",
        "authorized_official_telephone_number": "239-595-0821",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "16089",
            "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 Jan 5, 2016; 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.