Lake Myrtle Center for Advanced Dentistry

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN16643 Issued in FL

Legal business name

LAKE MYRTLE CENTER FOR ADVANCED DENTISTRY

Practice address

2016 US Highway 92 W
Auburndale, FL 33823-3921

Phone

(863) 662-9973

Fax

(863) 875-5736

NPI assigned

Mar 18, 2013

Organization subpart

No

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

Authorized official

Name

Henry Acosta, D.M.D,NPI 1417279217

Title

Dentist

Phone

(863) 662-9973

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Henry Acosta, DMD

  • General Practice Dentistry
  • Auburndale, FL
  • NPI 1417279217
  NPD (past) Authorized official
• Hafsa Tai, DDS

  • General Practice Dentistry
  • Auburndale, FL
  • NPI 1346519675
  NPD (past)

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

{
    "created_epoch": "1363564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363564800000",
    "number": "1477895464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2016 US HIGHWAY 92 W",
            "city": "AUBURNDALE",
            "state": "FL",
            "postal_code": "338233921",
            "telephone_number": "863-662-9973",
            "fax_number": "863-875-5736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2016 US HIGHWAY 92 W",
            "city": "AUBURNDALE",
            "state": "FL",
            "postal_code": "338233921",
            "telephone_number": "863-662-9973",
            "fax_number": "863-875-5736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE MYRTLE CENTER FOR ADVANCED DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-18",
        "last_updated": "2013-03-18",
        "status": "A",
        "authorized_official_last_name": "ACOSTA",
        "authorized_official_first_name": "HENRY",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "863-662-9973",
        "authorized_official_credential": "D.M.D,"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN16643",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Willie Johnson, GM
• Keith Jordan
• Nancy Davis King, M.D.
• Elizabeth Palachicacka Koshi, MD
• Michael Joseph Kyser
• Lakeland Regional Health Systems, Inc.
• Kimberley Lawrence
• Crystalyn Lawson
• Johnnie Lawson Jr.
• Ashtyn Brooke Leatherwood

• General Practice Dentistry in Auburndale, FL
• Providers in Auburndale, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2013; 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.