Organization Active NPI

Lakeland Periodontics, Inc

  • Periodontics
  • Lakeland, FL
National Provider Identifier
1508892225
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
Legal business name
LAKELAND PERIODONTICS, INC
Practice address
3003 S Florida Ave
Suite 201
Lakeland, FL 33803-4050
Phone
(863) 687-9227
Fax
(863) 687-2813
NPI assigned
Jun 24, 2006
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
Donna L Todd
Title
Insurance Coordinator
Phone
(863) 687-9227

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0300X Primary

Addresses

Primary practice location

3003 S Florida Ave
Suite 201
Lakeland, FL 33803-4050

Mailing address

3003 S Florida Ave
Suite 201
Lakeland, FL 33803-4050
Phone (863) 687-9227

National Provider Directory

National Provider Directory

Locations

3003 S Florida Ave
Ste 201
Lakeland, FL 33803
Phone (863) 687-9227

Practitioners & affiliated clinicians

Practitioners 2

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": "1151107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1508892225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3003 S FLORIDA AVE",
            "address_2": "SUITE 201",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338034050",
            "telephone_number": "863-687-9227",
            "fax_number": "863-687-2813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3003 S FLORIDA AVE",
            "address_2": "SUITE 201",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338034050",
            "telephone_number": "863-687-9227",
            "fax_number": "863-687-2813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKELAND PERIODONTICS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TODD",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "INSURANCE COORDINATOR",
        "authorized_official_telephone_number": "863-687-9227"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeland, 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.