Individual provider Active NPI

Anchana Rattanasena, DMD

  • Dentist
  • Trinity, FL
National Provider Identifier
1316783400
Registry record updated Aug 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN29325 Issued in FL
Practice address
3112 Little Rd
Trinity, FL 34655-1864
Phone
(727) 475-4852
NPI assigned
Jul 8, 2024
Last updated
Aug 28, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DN29325 FL Primary

Addresses

Primary practice location

3112 Little Rd
Trinity, FL 34655-1864

Mailing address

3112 Little Rd
Trinity, FL 34655-1864
Phone (727) 475-4852

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240925002541 FL Order and Referring Only - DentistPractitioner - Dentist 4688115041

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DN29325FLMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Dentists of Mitchell Ranch, PA CurrentSince Jul 21, 2024 Accepting new patients

Locations

3112 Little Rd
Trinity, FL 34655
Phone (727) 475-4852

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1720396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724803200000",
    "number": "1316783400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3112 LITTLE RD",
            "city": "TRINITY",
            "state": "FL",
            "postal_code": "346551864",
            "telephone_number": "727-475-4852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3112 LITTLE RD",
            "city": "TRINITY",
            "state": "FL",
            "postal_code": "346551864",
            "telephone_number": "727-475-4852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RATTANASENA",
        "first_name": "ANCHANA",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-08",
        "last_updated": "2024-08-28",
        "certification_date": "2024-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN29325",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Trinity, FL

Sources for this page

Verify at the official NPI Registry.