NPIMap

Organization Active NPI

Imagine Orthodontic Studio PLLC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Temple Terrace, FL
National Provider Identifier
1285200782
Registry record updated Jun 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
Legal business name
IMAGINE ORTHODONTIC STUDIO PLLC
Practice address
11502 N 56TH St
Temple Terrace, FL 33617-2239
Phone
(863) 462-4463
NPI assigned
Jun 3, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2021

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

Authorized official

Name
Michael Andrew Hess, DMD, MS
Title
Owner
Phone
(727) 743-8307

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223X0400X Primary

Addresses

Primary practice location

11502 N 56TH St
Temple Terrace, FL 33617-2239

Mailing address

3595 S Florida Ave
Lakeland, FL 33803-4860
Phone (863) 462-4463

Other identifiers 1

IdentifierTypeStateIssuer
1223X0400XMedicaidFL

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL http://www.imagineorthostudio.com Direct

National Provider Directory

National Provider Directory
Tax ID family
Imagine Orthodontic Studio PLLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

11502 N 56th St
Temple Terrace, FL 33617
Phone (863) 462-4463

Practitioners & affiliated clinicians

Practitioners 1

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": "1622678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622678400000",
    "number": "1285200782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3595 S FLORIDA AVE",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338034860",
            "telephone_number": "863-462-4463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11502 N 56TH ST",
            "city": "TEMPLE TERRACE",
            "state": "FL",
            "postal_code": "336172239",
            "telephone_number": "863-462-4463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMAGINE ORTHODONTIC STUDIO PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-03",
        "last_updated": "2021-06-03",
        "certification_date": "2021-06-03",
        "status": "A",
        "authorized_official_last_name": "HESS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "727-743-8307",
        "authorized_official_credential": "DMD, MS"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1223X0400X",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "http://www.imagineorthostudio.com",
            "affiliation": "N",
            "endpointDescription": "Website",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Website",
            "address_1": "11502 N 56th St",
            "city": "Temple Terrace",
            "state": "FL",
            "country_code": "US",
            "postal_code": "336172239",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Temple Terrace, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2021; 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.