Palm Beach Mall Dental Group

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

13591 Issued in FL

Legal business name

PALM BEACH MALL DENTAL GROUP

Practice address

1801 Palm Beach Lakes Blvd Ste 852
West Palm Beach, FL 33401-2003

Phone

(561) 683-6247

Fax

(561) 683-6248

NPI assigned

Apr 2, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Pamela Nielsen

Title

Dentist

Phone

(561) 683-6247

Specialties & licenses 1

Addresses

Tax ID family

Palm Beach Mall Dental Group2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Palm Beach Mall Dental Group,PL

  • General Practice Dentistry
  • West Palm Beach, FL
  • NPI 1497845440
  NPD tax ID

Locations

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1174644686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 PALM BEACH LAKES BLVD STE 852",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334012003",
            "telephone_number": "561-683-6247",
            "fax_number": "561-683-6248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 PALM BEACH LAKES BLVD STE 852",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334012003",
            "telephone_number": "561-683-6247",
            "fax_number": "561-683-6248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALM BEACH MALL DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "NIELSEN",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "561-683-6247",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "13591",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Palm Beach Hearing Care Centers, Inc.
• Palm Beach Infusion, Inc.
• Palm Beach Inpatient Specialists
• Palm Beach Institute
• Palm Beach International Surgery Center LLC
• Palm Beach Mall Dental Group,PL
• Palm Beach Mall Dental, PA
• Palm Beach Med Supplies LLC
• Palm Beach Med-Care PA
• Palm Beach Medical & Research Center, Inc

• General Practice Dentistry in West Palm Beach, FL
• Providers in West Palm Beach, 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 Aug 22, 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.