NPIMap

Organization Active NPI

Boulevard Center for Advanced Dentistry

  • Dental Clinic/Center
  • Port St Lucie, FL
National Provider Identifier
1275906232
Registry record updated Nov 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
DN13975 Issued in FL
Legal business name
BOULEVARD CENTER FOR ADVANCED DENTISTRY
Practice address
1343 SE Port St Lucie Blvd
Port St Lucie, FL 34952-5366
Phone
(772) 337-1111
NPI assigned
Nov 12, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2015

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

Authorized official

Name
Dr. Jerome Vitale, DMDNPI 1942423280
Title
Dentist/Owner
Phone
(772) 337-1111

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X DN13975 FL Primary

Addresses

Primary practice location

1343 SE Port St Lucie Blvd
Port St Lucie, FL 34952-5366

Mailing address

1343 SE Port St Lucie Blvd
Port St Lucie, FL 34952-5366

National Provider Directory

National Provider Directory

Locations

1343 SE Port St Lucie Blvd
Port St Lucie, FL 34952
Phone (772) 337-1111

Practitioners & affiliated clinicians

Practitioners 3

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": "1447286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447286400000",
    "number": "1275906232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1343 SE PORT ST LUCIE BLVD",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349525366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1343 SE PORT ST LUCIE BLVD",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349525366",
            "telephone_number": "772-337-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULEVARD CENTER FOR ADVANCED DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-12",
        "last_updated": "2015-11-12",
        "status": "A",
        "authorized_official_last_name": "VITALE",
        "authorized_official_first_name": "JEROME",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "772-337-1111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "FL",
            "license": "DN13975",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port St Lucie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 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.