The Smile Store-Palm Beach Gardens, P.a.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

Legal business name

THE SMILE STORE-PALM BEACH GARDENS, P.A.

Practice address

4362 Northlake Blvd Ste 114
Palm Beach Gardens, FL 33410-6269

Phone

(561) 658-4100

Fax

(866) 333-2309

NPI assigned

Mar 4, 2022

Organization subpart

No

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

Authorized official

Name

Dr. Nicholas J. Savastano Jr., DMD, MS

Title

Owner/Doctor

Phone

(561) 658-4100

Specialties & licenses 1

Addresses

Other identifiers 4

Electronic endpoints 1

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

{
    "created_epoch": "1646352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646352000000",
    "number": "1396492898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4362 NORTHLAKE BLVD STE 114",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334106269",
            "telephone_number": "561-658-4100",
            "fax_number": "866-333-2309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4362 NORTHLAKE BLVD STE 114",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334106269",
            "telephone_number": "561-658-4100",
            "fax_number": "866-333-2309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SMILE STORE-PALM BEACH GARDENS, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-04",
        "last_updated": "2022-03-04",
        "certification_date": "2022-03-04",
        "status": "A",
        "authorized_official_last_name": "SAVASTANO",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "OWNER/DOCTOR",
        "authorized_official_telephone_number": "561-658-4100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DMD, MS"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "105737100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TYPE 1 NPI PROVIDER ID DR. SAVASTANO",
            "identifier": "1154348233",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI 2 OF OLD TIN/LLC NAME FOR SAME DOCTOR, SAME LOCATION",
            "identifier": "1518505692",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "DN15487",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Outlook365",
            "affiliation": "N",
            "endpointDescription": "Insurance@teamcos.com",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "4362 Northlake Blvd Ste 114",
            "city": "Palm Beach Gardens",
            "state": "FL",
            "country_code": "US",
            "postal_code": "334106269",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Orthodontics and Dentofacial Orthopedics Dentistry in Palm Beach Gardens, FL
• Providers in Palm Beach Gardens, FL by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2022; 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.