NPIMap

Organization Active NPI

Main Street Children's Dentistry of Wellington

  • Pediatric Dentistry
  • Royal Palm Beach, FL
National Provider Identifier
1275084345
Registry record updated Oct 24, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
DN22345 Issued in FL
Legal business name
MAIN STREET CHILDREN'S DENTISTRY OF WELLINGTON
Practice address
11903 Southern Blvd
Suite 102
Royal Palm Beach, FL 33411-7644
Phone
(561) 459-2733
NPI assigned
Oct 24, 2016
Last updated
Oct 24, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2016

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

Authorized official

Name
Stephanie Gomez
Title
Credentialing Coordinator
Phone
(305) 274-2499

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X DN22345 FL Primary

Addresses

Primary practice location

11903 Southern Blvd
Suite 102
Royal Palm Beach, FL 33411-7644

Mailing address

11903 Southern Blvd
Suite 102
Royal Palm Beach, FL 33411-7644
Phone (561) 459-2733

National Provider Directory

National Provider Directory
Tax ID family
Main Street Children's Dentistry of Wellington3 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

11903 Southern Blvd
Ste 102
Royal Palm Beach, FL 33411
Phone (561) 422-2940

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1477267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477267200000",
    "number": "1275084345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11903 SOUTHERN BLVD",
            "address_2": "SUITE 102",
            "city": "ROYAL PALM BEACH",
            "state": "FL",
            "postal_code": "334117644",
            "telephone_number": "561-459-2733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11903 SOUTHERN BLVD",
            "address_2": "SUITE 102",
            "city": "ROYAL PALM BEACH",
            "state": "FL",
            "postal_code": "334117644",
            "telephone_number": "561-459-2733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET CHILDREN'S DENTISTRY OF WELLINGTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-24",
        "last_updated": "2016-10-24",
        "status": "A",
        "authorized_official_last_name": "GOMEZ",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "305-274-2499"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "FL",
            "license": "DN22345",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Royal Palm Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2016; 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.