NPIMap

Organization Active NPI

CDPG, P.L.

  • General Practice Dentistry
  • Titusville, FL
National Provider Identifier
1508527243
Registry record updated Jul 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
CDPG, P.L.
Practice address
696 Country Club Dr
Titusville, FL 32780-4977
Phone
(321) 383-7828
NPI assigned
Jan 5, 2022
Organization subpart
Yes
Parent organization
CDPG, P.L.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 14, 2025

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

Authorized official

Name
Celia Hayes
Title
Credentialing Coordinator
Phone
(217) 540-2100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

696 Country Club Dr
Titusville, FL 32780-4977

Mailing address

696 Country Club Dr
Titusville, FL 32780-4977
Phone (321) 383-7828

Other names 1

  • Miracle City Dentistry Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Christie Dental Practice Group16 organizations share this tax ID, including this one
Part of
Christie Dental Practice Group

Other organizations with this tax ID 15

Organizations that report the same tax identification number in the National Provider Directory.

View all 15

Locations

696 Country Club Dr
Titusville, FL 32780
Phone (321) 383-7828

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1641340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752451200000",
    "number": "1508527243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "696 COUNTRY CLUB DR",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327804977",
            "telephone_number": "321-383-7828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "696 COUNTRY CLUB DR",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327804977",
            "telephone_number": "321-383-7828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CDPG, P.L.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CDPG, P.L.",
        "enumeration_date": "2022-01-05",
        "last_updated": "2025-07-14",
        "certification_date": "2025-07-14",
        "status": "A",
        "authorized_official_last_name": "HAYES",
        "authorized_official_first_name": "CELIA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-2100"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Miracle City Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Titusville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2025; 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.