Professional Dental Alliance of Bayside Lakes, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

PROFESSIONAL DENTAL ALLIANCE OF BAYSIDE LAKES, PLLC

Practice address

3590 Bayside Lakes Blvd SE Ste 1
Palm Bay, FL 32909-6866

Phone

(321) 984-0044

Fax

(321) 984-0707

NPI assigned

Aug 13, 2018

Organization subpart

No

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

Authorized official

Name

Annette Marlow

Title

Credentialing Supervisor

Phone

(724) 698-2119

Specialties & licenses 1

Addresses

Other names 1

• New Image Dentistry Bayside Lakes Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Karan Doomra, DDS

  • General Practice Dentistry
  • Palm Bay, FL
  • NPI 1942650155
  NPD (past)
• Lina Alejandra Ramirez, DMD

  • Dentist
  • Palm Bay, FL
  • NPI 1679002604
  NPD (past)

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

{
    "created_epoch": "1534118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534118400000",
    "number": "1346729167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 S MILL ST STE 200",
            "city": "NEW CASTLE",
            "state": "PA",
            "postal_code": "161013680",
            "telephone_number": "724-698-2119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3590 BAYSIDE LAKES BLVD SE STE 1",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329096866",
            "telephone_number": "321-984-0044",
            "fax_number": "321-984-0707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL DENTAL ALLIANCE OF BAYSIDE LAKES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-13",
        "last_updated": "2018-08-13",
        "status": "A",
        "authorized_official_last_name": "MARLOW",
        "authorized_official_first_name": "ANNETTE",
        "authorized_official_title_or_position": "CREDENTIALING SUPERVISOR",
        "authorized_official_telephone_number": "724-698-2119"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "New Image Dentistry Bayside Lakes",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Prime Movers Rehab, Inc.
• Coralie Prince, RN
• Sharma Jo Privett
• Vikash Priyadarshi, MD
• Proclaim Communication and Rehabilitation Services, LLC
• Professional Dental Alliance of Minton, PLLC
• Professional Dental Alliance of Palm Bay Palm Bay Rd, PLLC
• Professional Dental Alliance of Palm Bay, PLLC
• Rebecca Dawn Proffitt, NP
• Ariel Prothro

• General Practice Dentistry in Palm Bay, FL
• Providers in Palm Bay, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2018; 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.