Individual provider Active NPI

Joanna Bala, DDS

  • Dentist
  • Seminole, FL
National Provider Identifier
1144743774
Registry record updated Apr 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
22775 Issued in FL
Practice address
9303 Seminole Blvd Ste D
Seminole, FL 33772-3100
Phone
(727) 548-5454
NPI assigned
Jul 25, 2017
Last updated
Apr 26, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 22775 FL Primary

Addresses

Primary practice location

9303 Seminole Blvd Ste D
Seminole, FL 33772-3100

Mailing address

1204 E Cumberland Ave Unit 430
Tampa, FL 33602-4233
Phone (561) 537-6763

Other practice location 1

1243 Lakeview Rd
Clearwater, FL 33756-3587
Phone (727) 443-7353

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200122000917 FL Order and Referring Only - DentistPractitioner - Dentist 9931534930

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
22775FLMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Neil M Brodsky DDS PA PastSince May 16, 2021 Accepting new patients
Virginia M. Melmed, D.D.S., P.a. PastSince Mar 5, 2023 Accepting new patients

Networks

  • Freedom Health HMO Network

Organizations & group practices 2

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": "1500940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619395200000",
    "number": "1144743774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1204 E CUMBERLAND AVE UNIT 430",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336024233",
            "telephone_number": "561-537-6763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9303 SEMINOLE BLVD STE D",
            "city": "SEMINOLE",
            "state": "FL",
            "postal_code": "337723100",
            "telephone_number": "727-548-5454"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1243 Lakeview Rd",
            "address_purpose": "LOCATION",
            "city": "Clearwater",
            "state": "FL",
            "postal_code": "337563587",
            "country_code": "US",
            "telephone_number": "727-443-7353",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BALA",
        "first_name": "JOANNA",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-25",
        "last_updated": "2021-04-26",
        "certification_date": "2021-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "22775",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Seminole, FL

Sources for this page

Verify at the official NPI Registry.