NPIMap

Individual provider Active NPI

Mounika Falemban, DDS

  • Pediatric Dentistry
  • Gibsonton, FL
National Provider Identifier
1144472713
Registry record updated Jun 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
18289 Issued in FL
Practice address
13127 Kings Lake Dr Unit 101
Gibsonton, FL 33534-3958
Phone
(813) 677-3047
Fax
(813) 284-7959
NPI assigned
Oct 15, 2008
Last updated
Jun 30, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 30, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 18289 FL
Pediatric Dentistry 1223P0221X 18289 FL Primary

Addresses

Primary practice location

13127 Kings Lake Dr Unit 101
Gibsonton, FL 33534-3958

Mailing address

6815 Scenic Dr
Apollo Beach, FL 33572-1543
Phone (813) 408-4634

Other identifiers 4

IdentifierTypeStateIssuer
007161100MedicaidFL
9309OtherFLMCNA
2188062MedicaidTX
1144472713OtherFLDENTAQUEST

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
18289FLMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Kidzone Dentistry PA Dentist CurrentSince Jul 5, 2020 Accepting new patients
Thai Pham DMD PA PastSince Jul 5, 2020 Accepting new patients
Happy Kids Pediatric Dentistry Pediatric Dentistry Past Accepting new patients

Locations

13127 Kings Lake Dr
Unit 101
Gibsonton, FL 33534
Phone (813) 284-7958

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1224028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593475200000",
    "number": "1144472713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6815 SCENIC DR",
            "city": "APOLLO BEACH",
            "state": "FL",
            "postal_code": "335721543",
            "telephone_number": "813-408-4634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13127 KINGS LAKE DR UNIT 101",
            "city": "GIBSONTON",
            "state": "FL",
            "postal_code": "335343958",
            "telephone_number": "813-677-3047",
            "fax_number": "813-284-7959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FALEMBAN",
        "first_name": "MOUNIKA",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-10-15",
        "last_updated": "2020-06-30",
        "certification_date": "2020-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "18289",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "FL",
            "license": "18289",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007161100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCNA",
            "identifier": "9309",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2188062",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAQUEST",
            "identifier": "1144472713",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gibsonton, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2020; 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.