Individual provider Active NPI

Mary Ann Palenzuela, DMD

  • General Practice Dentistry
  • Plantation, FL
National Provider Identifier
1366498990
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
14352 Issued in FL
Practice address
10080 NW 1St CT
Plantation, FL 33324-7035
Phone
(954) 474-8977
Fax
(954) 474-8946
NPI assigned
May 25, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 14352 FL Primary

Addresses

Primary practice location

10080 NW 1St CT
Plantation, FL 33324-7035

Mailing address

10080 NW 1St CT
Plantation, FL 33324-7035
Phone (954) 474-8977

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
I20160307000456 FL Order and Referring Only - DentistPractitioner - Dentist 4688970361

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
14352FLMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Plantation Dental Associates, PL General Practice Past Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1366498990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10080 NW 1ST CT",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333247035",
            "telephone_number": "954-474-8977",
            "fax_number": "954-474-8946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10080 NW 1ST CT",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333247035",
            "telephone_number": "954-474-8977",
            "fax_number": "954-474-8946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PALENZUELA",
        "first_name": "MARY ANN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-25",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "14352",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plantation, FL

Sources for this page

Verify at the official NPI Registry.