Professional Dental Alliance of Palm Bay Palm Bay Rd, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

PROFESSIONAL DENTAL ALLIANCE OF PALM BAY PALM BAY RD, PLLC

Practice address

1890 Palm Bay Rd NE Ste 2
Palm Bay, FL 32905-3071

Phone

(321) 724-5100

NPI assigned

Sep 17, 2019

Last updated

Sep 17, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lauren Howard

Title

Credentialing Specialist

Phone

(757) 576-5479

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, and the practitioner matching its NPPES authorized official.

• Destiny Faith Wolcott, DMD

  • Dentist
  • Palm Bay, FL
  • NPI 1952144529
  NPD
• Atm N Amin, BDS

  • Dentist
  • Palm Bay, FL
  • NPI 1154439628
  NPD (past)

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

{
    "created_epoch": "1568678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568678400000",
    "number": "1518517077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 S MILL ST STE 200",
            "city": "NEW CASTLE",
            "state": "PA",
            "postal_code": "161013680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1890 PALM BAY RD NE STE 2",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329053071",
            "telephone_number": "321-724-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL DENTAL ALLIANCE OF PALM BAY PALM BAY RD, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-17",
        "last_updated": "2019-09-17",
        "status": "A",
        "authorized_official_last_name": "HOWARD",
        "authorized_official_first_name": "LAUREN",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "757-576-5479"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Privia Medical Group Florida LLC (Jeffrey T. O'Brien, MD, Inc. DBA The Orthopedic Center)
• Vikash Priyadarshi, MD
• Proclaim Communication and Rehabilitation Services, LLC
• Professional Dental Alliance of Bayside Lakes, PLLC (New Image Dentistry Bayside Lakes)
• Professional Dental Alliance of Minton, PLLC (New Image Dentistry Minton)
• Professional Dental Alliance of Palm Bay, PLLC (Palm Bay Dental Center)
• Rebecca Dawn Proffitt, NP
• Ariel Prothro
• PT Malabar Chiropractic Clinic Inc (Port Malabar Chiropractic)
• Publix Super Markets Inc (Publix Pharmacy #0424)

• General Practice Dentistry in Palm Bay, FL
• Providers in Palm Bay, 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 Sep 17, 2019; 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.