NPIMap

Organization Active NPI

BWM Dentistry PA

  • General Practice Dentistry
  • Tallahassee, FL
National Provider Identifier
1447753090
Registry record updated Jun 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
BWM DENTISTRY PA
Practice address
1415 Governors Square Blvd
Tallahassee, FL 32301-3049
Phone
(850) 688-9095
NPI assigned
Mar 9, 2018
Last updated
Jun 20, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2023

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

Authorized official

Name
Brandon Meckelberg
Title
Owner
Phone
(850) 688-9095

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

1415 Governors Square Blvd
Tallahassee, FL 32301-3049

Mailing address

PO Box 70887
Cleveland, OH 44190-0887

National Provider Directory

National Provider Directory

Locations

1415 Governors Square Blvd
Tallahassee, FL 32301
Phone (850) 583-5748

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1520553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687219200000",
    "number": "1447753090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70887",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441900887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 GOVERNORS SQUARE BLVD",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323013049",
            "telephone_number": "850-688-9095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BWM DENTISTRY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-09",
        "last_updated": "2023-06-20",
        "certification_date": "2023-06-20",
        "status": "A",
        "authorized_official_last_name": "MECKELBERG",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "850-688-9095"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tallahassee, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2023; 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.