NPIMap

Organization Active NPI

Professional Dental Alliance of Lake Washington, PLLC

Doing business as New Image Dentistry Lake Washington

  • General Practice Dentistry
  • Melbourne, FL
National Provider Identifier
1558840371
Registry record updated Aug 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
PROFESSIONAL DENTAL ALLIANCE OF LAKE WASHINGTON, PLLC
Doing business as
New Image Dentistry Lake Washington
Practice address
3226 Lake Washington Rd Ste 16
Melbourne, FL 32934-7620
Phone
(321) 255-1991
NPI assigned
Aug 13, 2018
Last updated
Aug 13, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2018

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

Authorized official

Name
Annette Marlow
Title
Credentialing Supervisor
Phone
(724) 698-2119

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

3226 Lake Washington Rd Ste 16
Melbourne, FL 32934-7620

Mailing address

11 S Mill St Ste 200
New Castle, PA 16101-3680
Phone (724) 698-2500

Other names 1

  • New Image Dentistry Lake Washington Doing business as

National Provider Directory

National Provider Directory

Locations

3226 Lake Washington Rd
Ste 16
Melbourne, FL 32934
Phone (321) 255-1991

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1534118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534118400000",
    "number": "1558840371",
    "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",
            "telephone_number": "724-698-2500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3226 LAKE WASHINGTON RD STE 16",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329347620",
            "telephone_number": "321-255-1991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL DENTAL ALLIANCE OF LAKE WASHINGTON, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-13",
        "last_updated": "2018-08-13",
        "status": "A",
        "authorized_official_last_name": "MARLOW",
        "authorized_official_first_name": "ANNETTE",
        "authorized_official_title_or_position": "CREDENTIALING SUPERVISOR",
        "authorized_official_telephone_number": "724-698-2119"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "New Image Dentistry Lake Washington",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Melbourne, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2018; 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.