Innovative Dental Solution of Brandon,LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

INNOVATIVE DENTAL SOLUTION OF BRANDON,LLC

Practice address

926 W Lumsden Rd
Brandon, FL 33511-6281

Phone

(813) 438-8728

Fax

(813) 438-8730

NPI assigned

Dec 5, 2016

Organization subpart

No

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

Authorized official

Name

Sylvia L Miller

Title

Insurance Specialist

Phone

(321) 431-2208

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1480896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480896000000",
    "number": "1376087742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "926 W LUMSDEN RD",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335116281",
            "telephone_number": "813-438-8728",
            "fax_number": "813-438-8730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "926 W LUMSDEN RD",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335116281",
            "telephone_number": "813-438-8728",
            "fax_number": "813-438-8730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE DENTAL SOLUTION OF BRANDON,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-05",
        "last_updated": "2016-12-05",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "SYLVIA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "INSURANCE SPECIALIST",
        "authorized_official_telephone_number": "321-431-2208"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2016; 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.