Providence Dental LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

PROVIDENCE DENTAL LLC

Practice address

12450 E. Colonial Drive Suite 124
Orlando, FL 32826

Phone

(407) 635-0704

Fax

(407) 286-0439

NPI assigned

Sep 19, 2018

Organization subpart

No

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

Authorized official

Name

Nadia Kahook

Title

Credentialing Consultant

Phone

(954) 446-5797

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1537315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1537315200000",
    "number": "1407330145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12450 E. COLONIAL DRIVE SUITE 124",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "32826",
            "telephone_number": "407-635-0704",
            "fax_number": "407-286-0439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12450 E. COLONIAL DRIVE SUITE 124",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "32826",
            "telephone_number": "407-635-0704",
            "fax_number": "407-286-0439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-19",
        "last_updated": "2018-09-19",
        "status": "A",
        "authorized_official_last_name": "KAHOOK",
        "authorized_official_first_name": "NADIA",
        "authorized_official_title_or_position": "CREDENTIALING CONSULTANT",
        "authorized_official_telephone_number": "954-446-5797"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Protean Biodiagnostics Inc
• Protean Pathology Services LLC
• Rachel Andie Simon Proulx, MPT
• Kristin Lea Hood Provencher, CPNP-PC
• Providence Academy, Inc
• Providence Home
• Providence Personal Care PPC
• Juliet D Providence
• Providential Health & Rehab, Inc.
• Justin Provido

• Dentist in Orlando, FL
• Providers in Orlando, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 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.