Individual provider Active NPI

Allison Konick, DMD

  • General Practice Dentistry
  • Lakewood Ranch, FL
National Provider Identifier
1508152067
Registry record updated May 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
19386 Issued in FL
Practice address
11155 State Road 70 East
Lakewood Ranch, FL 34202
Phone
(941) 953-5565
Fax
(813) 336-0836
NPI assigned
Jun 23, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 28, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 19386 FL Primary

Addresses

Primary practice location

11155 State Road 70 East
Lakewood Ranch, FL 34202

Mailing address

11155 State Road 70 East
Lakewood Ranch, FL 34202-1307
Phone (941) 953-5565

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
19386FLMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Kind Smiles Dental Health CurrentSince Jun 22, 2021 Accepting new patients

Locations

11155 State Road 70 E
Lakewood Ranch, FL 34202
Phone (941) 253-5565

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1308787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622160000000",
    "number": "1508152067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11155 STATE ROAD 70 EAST",
            "city": "LAKEWOOD RANCH",
            "state": "FL",
            "postal_code": "342021307",
            "telephone_number": "941-953-5565",
            "fax_number": "813-336-0836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11155 STATE ROAD 70 EAST",
            "city": "LAKEWOOD RANCH",
            "state": "FL",
            "postal_code": "34202",
            "telephone_number": "941-953-5565",
            "fax_number": "813-336-0836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KONICK",
        "first_name": "ALLISON",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-23",
        "last_updated": "2021-05-28",
        "certification_date": "2021-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "19386",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood Ranch, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2021; 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.