Deep Roots Project, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

DEEP ROOTS PROJECT, LLC

Practice address

4302 Henderson Blvd Ste 117
Tampa, FL 33629-5693

Phone

(813) 839-2273

Fax

(813) 839-2206

NPI assigned

Feb 29, 2024

Last updated

Feb 29, 2024By 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

Mrs. Jennifer Nicole Vega

Title

Practice Manager

Phone

(813) 839-2273

Specialties & licenses 1

Addresses

Other names 1

• Deep Roots Project LLC Other name

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.

• Marnie Chall Bauer, DMD

  • Dentist
  • Tampa, FL
  • NPI 1013124387
  NPD
• Jennifer Lindsay Marks, DDS

  • General Practice Dentistry
  • Tampa, FL
  • NPI 1316479959
  NPD (past)

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

{
    "created_epoch": "1709164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709164800000",
    "number": "1548027204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4302 HENDERSON BLVD STE 117",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336295693",
            "telephone_number": "813-839-2273",
            "fax_number": "813-839-2206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4302 HENDERSON BLVD STE 117",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336295693",
            "telephone_number": "813-839-2273",
            "fax_number": "813-839-2206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEEP ROOTS PROJECT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-29",
        "last_updated": "2024-02-29",
        "certification_date": "2024-02-29",
        "status": "A",
        "authorized_official_last_name": "VEGA",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "813-839-2273",
        "authorized_official_name_prefix": "Mrs."
    },
    "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": "Deep Roots Project LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Ralph J Dedomenico, DMD
• Shannon Elizabeth Dedomenico, MA, CCC-SLP
• Alex R Deem, MD
• Deen G King MD PA
• Deanna Deenihan
• Deepak Naidu MD, PA (Deepak K. Naidu, MD Plastic Surgery)
• Collin Dees, PA-C
• Antoinette C Defazio, PH.D
• Theodore Anthony Defelice
• Anna Defilippis, MD

• General Practice Dentistry in Tampa, FL
• Providers in Tampa, 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 Feb 29, 2024; 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.