NPIMap

Organization Active NPI

Pediatric Dental Group, LLC

  • Pediatric Dentistry
  • Orlando, FL
National Provider Identifier
1235697707
Registry record updated Mar 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
PEDIATRIC DENTAL GROUP, LLC
Practice address
12601 Narcoossee Rd
Unite 100a
Orlando, FL 32832
Phone
(407) 737-7767
Fax
(407) 737-0769
NPI assigned
Mar 4, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2019

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

Authorized official

Name
Olubisi Alna, DMD
Title
Co-Owner
Phone
(407) 737-7767

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X Primary

Addresses

Primary practice location

12601 Narcoossee Rd
Unite 100a
Orlando, FL 32832

Mailing address

9161 Narcoossee Rd
Ste 101B
Orlando, FL 32827
Phone (407) 737-7767

National Provider Directory

National Provider Directory
Tax ID family
Pediatric Dental Group3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

12601 Narcoossee Rd
#100A
Orlando, FL 32832
Phone (407) 737-7767

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1551657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551657600000",
    "number": "1235697707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9161 NARCOOSSEE RD",
            "address_2": "STE 101B",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "32827",
            "telephone_number": "407-737-7767",
            "fax_number": "407-737-0769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12601 NARCOOSSEE RD",
            "address_2": "UNITE 100A",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "32832",
            "telephone_number": "407-737-7767",
            "fax_number": "407-737-0769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-04",
        "last_updated": "2019-03-04",
        "status": "A",
        "authorized_official_last_name": "ALNA",
        "authorized_official_first_name": "OLUBISI",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "407-737-7767",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2019; 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.