NPIMap

Individual provider Active NPI

Justin Lieneck, D.M.D., P.A.

  • General Practice Dentistry
  • Melbourne, FL
National Provider Identifier
1194012575
Registry record updated Apr 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN19412 Issued in FL
Practice address
811 S Babcock St
Melbourne, FL 32901-1890
Phone
(321) 729-0022
NPI assigned
Jul 6, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 30, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DN19412 FL Primary

Addresses

Primary practice location

811 S Babcock St
Melbourne, FL 32901-1890

Mailing address

811 S Babcock St
Melbourne, FL 32901-1890
Phone (321) 729-0022

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
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
DN19412FLMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Nikhita Shree Kumar Inc. General Practice Past Accepting new patients

Networks

  • Freedom Health HMO Network

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1309910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335744000000",
    "number": "1194012575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 S BABCOCK ST",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329011890",
            "telephone_number": "321-729-0022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 S BABCOCK ST",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329011890",
            "telephone_number": "321-729-0022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIENECK",
        "first_name": "JUSTIN",
        "name_prefix": "Dr.",
        "credential": "D.M.D., P.A.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-07-06",
        "last_updated": "2012-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN19412",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Melbourne, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2012; 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.