NPIMap

Organization Active NPI

Dynamic Dental Health Associates of Florida, PA

  • General Practice Dentistry
  • Venice, FL
National Provider Identifier
1316377641
Registry record updated Feb 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN11595 Issued in FL
Legal business name
DYNAMIC DENTAL HEALTH ASSOCIATES OF FLORIDA, PA
Practice address
1214 E Venice Ave Ste B
Venice, FL 34285-7165
Phone
(941) 484-8481
Fax
(941) 485-6101
NPI assigned
Nov 22, 2013
Reactivated
Aug 12, 2020
Organization subpart
Yes
Parent organization
DYNAMIC DENTAL HEALTH ASSOCIATES OF FLORIDA, PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 2, 2024

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

Authorized official

Name
Rosa Lesso
Title
National Director of RCM
Phone
(714) 571-3471

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X DN11595 FL Primary

Addresses

Primary practice location

1214 E Venice Ave Ste B
Venice, FL 34285-7165

Mailing address

136 4TH St N Ste 201
St Petersburg, FL 33701-3889
Phone (727) 800-8026

Other names 1

  • Waterside Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dynamic Dental Health Associates of Florida13 organizations share this tax ID, including this one
Part of
Dynamic Dental Health Associates of Florida

Other organizations with this tax ID 12

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

Locations

333 Tamiami Trl S
Ste 383
Venice, FL 34285
Phone (941) 480-0900

1214 E Venice Ave
Ste B
Venice, FL 34285
Phone (941) 294-0600

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": "1385078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706832000000",
    "number": "1316377641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "136 4TH ST N STE 201",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337013889",
            "telephone_number": "727-800-8026",
            "fax_number": "727-304-3164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1214 E VENICE AVE STE B",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "342857165",
            "telephone_number": "941-484-8481",
            "fax_number": "941-485-6101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC DENTAL HEALTH ASSOCIATES OF FLORIDA, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DYNAMIC DENTAL HEALTH ASSOCIATES OF FLORIDA, PA",
        "enumeration_date": "2013-11-22",
        "last_updated": "2024-02-02",
        "certification_date": "2024-02-02",
        "deactivation_date": "2020-07-09",
        "reactivation_date": "2020-08-12",
        "status": "A",
        "authorized_official_last_name": "LESSO",
        "authorized_official_first_name": "ROSA",
        "authorized_official_title_or_position": "NATIONAL DIRECTOR OF RCM",
        "authorized_official_telephone_number": "714-571-3471"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN11595",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Waterside Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Waterside Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Venice, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2024; 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.