Reza Ardalan DMD PA

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

REZA ARDALAN DMD PA

Practice address

130 SW Chamber CT
Port Saint Lucie, FL 34986-3496

Phone

(772) 344-4664

Fax

(772) 621-4498

NPI assigned

Jun 5, 2026

Organization subpart

No

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

Authorized official

Name

Kimberly M Ardalan

Title

Cfo

Phone

(772) 344-4664

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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

• Amir Reza Ardalan, DMD

  • Pediatric Dentistry
  • Port St Lucie, FL
  • NPI 1093873820
  NPD
• Christie Leeann Michaud, DMD

  • Pediatric Dentistry
  • Port Saint Lucie, FL
  • NPI 1922238815
  NPD

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

{
    "created_epoch": "1780617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780617600000",
    "number": "1356274542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 SW CHAMBER CT",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349863496",
            "telephone_number": "772-344-4664",
            "fax_number": "772-621-4498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 SW CHAMBER CT",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349863496",
            "telephone_number": "772-344-4664",
            "fax_number": "772-621-4498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REZA ARDALAN DMD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-06-05",
        "last_updated": "2026-06-05",
        "certification_date": "2026-06-05",
        "status": "A",
        "authorized_official_last_name": "ARDALAN",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "772-344-4664"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lissette Reyes, RN
• Alyssa Michelle Reynolds, RBT
• Stephanie Michelle Reynolds, M.S.
• Susan Reynolds
• Rez Med Medical Supply LLC
• Jillian L Ricard
• Richard Cruz Capital LLC (Thrive first home care)
• Richard J Pena- Ariet MD PA
• Alicia Richardson
• Zeobia Sherease Richardson

• Pediatric Dentistry in Port Saint Lucie, FL
• Providers in Port Saint Lucie, FL by specialty
• Pediatric Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2026; 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.