Ellenton Family Dental Corp

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

ELLENTON FAMILY DENTAL CORP

Practice address

5975 Factory Shops Blvd
Ellenton, FL 34222-4125

Phone

(941) 479-7936

Fax

(941) 479-7991

NPI assigned

Sep 14, 2015

Last updated

Sep 14, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Carla M Mathews

Title

Office Manager

Phone

(941) 479-7936

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1442188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442188800000",
    "number": "1184092629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5975 FACTORY SHOPS BLVD",
            "city": "ELLENTON",
            "state": "FL",
            "postal_code": "342224125",
            "telephone_number": "941-479-7936",
            "fax_number": "941-479-7991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5975 FACTORY SHOPS BLVD",
            "city": "ELLENTON",
            "state": "FL",
            "postal_code": "342224125",
            "telephone_number": "941-479-7936",
            "fax_number": "941-479-7991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLENTON FAMILY DENTAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-14",
        "last_updated": "2015-09-14",
        "status": "A",
        "authorized_official_last_name": "MATHEWS",
        "authorized_official_first_name": "CARLA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "941-479-7936"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dental Clinic/Center in Ellenton, FL
• Providers in Ellenton, 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 Sep 14, 2015; 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.