Pongsakorn Poovarodom, DDS, MSC, PHD

Primary specialty

ProsthodonticsTaxonomy code 1223P0700X

License

884 Issued in FL

Practice address

1395 Center Drive
Gainesville, FL 32610-0415

Phone

(854) 858-2195

NPI assigned

Jul 24, 2024

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

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

{
    "created_epoch": "1721779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787702400000",
    "number": "1558199257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100415",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326100415",
            "telephone_number": "854-858-2195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1395 CENTER DRIVE",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326100415",
            "telephone_number": "854-858-2195"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "173 Ashley Ave # Msc507",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "SC",
            "postal_code": "294258908",
            "country_code": "US",
            "telephone_number": "843-792-3811",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POOVARODOM",
        "first_name": "PONGSAKORN",
        "name_prefix": "Dr.",
        "credential": "DDS, MSC, PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-07-24",
        "last_updated": "2026-08-26",
        "certification_date": "2026-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "SC",
            "license": "60",
            "primary": false
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "FL",
            "license": "884",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Pontzer
• Belinda Shannettee Poole
• Nancy Poole
• Shana Poole
• Nakechand R Pooran, MD
• Ebonie L Pope
• Haley Pope, MOTR/L
• Samantha Pope
• Melodie E Poplin, PA-C
• Deborah M Popovich, MSN, ARNP, CPNP

• Prosthodontics in Gainesville, FL
• Providers in Gainesville, FL by specialty
• Prosthodontics in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2026; 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.