NPIMap

Organization Active NPI

New Image Dentisty of Palm Bay

  • General Practice Dentistry
  • Palm Bay, FL
National Provider Identifier
1285047506
Registry record updated Jun 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN19771 Issued in FL
Legal business name
NEW IMAGE DENTISTY OF PALM BAY
Practice address
3590 Bayside Lakes Blvd SE
Palm Bay, FL 32909-6866
Phone
(321) 984-0044
Fax
(321) 984-0707
NPI assigned
Jun 4, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2014

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

Authorized official

Name
Mohammed Mujeeb
Title
Owner
Phone
(321) 434-4444

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X DN19771 FL Primary

Addresses

Primary practice location

3590 Bayside Lakes Blvd SE
Palm Bay, FL 32909-6866

Mailing address

3590 Bayside Lakes Blvd SE
Palm Bay, FL 32909-6866
Phone (321) 984-0044

National Provider Directory

National Provider Directory

Locations

3590 Bayside Lakes Blvd SE
Palm Bay, FL 32909
Phone (321) 544-7036

Practitioners & affiliated clinicians

Practitioners 7

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": "1401840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401840000000",
    "number": "1285047506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3590 BAYSIDE LAKES BLVD SE",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329096866",
            "telephone_number": "321-984-0044",
            "fax_number": "321-984-0707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3590 BAYSIDE LAKES BLVD SE",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329096866",
            "telephone_number": "321-984-0044",
            "fax_number": "321-984-0707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW IMAGE DENTISTY OF PALM BAY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-04",
        "last_updated": "2014-06-04",
        "status": "A",
        "authorized_official_last_name": "MUJEEB",
        "authorized_official_first_name": "MOHAMMED",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "321-434-4444"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN19771",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Bay, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2014; 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.