NPIMap

Organization Active NPI

Dermatology and Skin Surgery Center, PA

  • Dermatology Physician
  • Celebration, FL
National Provider Identifier
1477640902
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
ME0058612 Issued in FL
Legal business name
DERMATOLOGY AND SKIN SURGERY CENTER, PA
Practice address
410 Celebration PL
Suite 301
Celebration, FL 34747-5433
Phone
(407) 566-1616
NPI assigned
Oct 6, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Dean R Goodless, MDNPI 1932120326
Title
President
Phone
(407) 566-1616

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X ME0058612 FL Primary

Addresses

Primary practice location

410 Celebration PL
Suite 301
Celebration, FL 34747-5433

Mailing address

410 Celebration PL
Suite 301
Celebration, FL 34747-5433
Phone (407) 566-1616

National Provider Directory

National Provider Directory

Locations

410 Celebration Pl
Ste 301
Kissimmee, FL 34747
Phone (407) 566-1616

Practitioners & affiliated clinicians

Practitioners 1

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": "1160092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1477640902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 CELEBRATION PL",
            "address_2": "SUITE 301",
            "city": "CELEBRATION",
            "state": "FL",
            "postal_code": "347475433",
            "telephone_number": "407-566-1616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 CELEBRATION PL",
            "address_2": "SUITE 301",
            "city": "CELEBRATION",
            "state": "FL",
            "postal_code": "347475433",
            "telephone_number": "407-566-1616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY AND SKIN SURGERY CENTER, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GOODLESS",
        "authorized_official_first_name": "DEAN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "407-566-1616",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "FL",
            "license": "ME0058612",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Celebration, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.