NPIMap

Organization Active NPI

Family Dentistry Cosmetic Dentistry

  • Dentist
  • Coconut Creek, FL
National Provider Identifier
1568813491
Registry record updated Jun 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN13436 Issued in FL
Legal business name
FAMILY DENTISTRY COSMETIC DENTISTRY
Practice address
5359 Lyons Rd
Coconut Creek, FL 33073-2825
Phone
(954) 570-8870
Fax
(954) 571-6736
NPI assigned
Jun 22, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2016

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

Authorized official

Name
Dr. Manon Bourque HutchisonNPI 1144370818
Title
Owner
Phone
(954) 570-8870

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X DN13436 FL Primary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X DN5044 FL
EndodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223E0200X DN19185 FL
PeriodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0300X DN0011990 FL
Dental HygienistGroup: 193200000X MULTI-SPECIALTY GROUP 124Q00000X DH15026 FL

Addresses

Primary practice location

5359 Lyons Rd
Coconut Creek, FL 33073-2825

Mailing address

5359 Lyons Rd
Coconut Creek, FL 33073-2825
Phone (954) 570-8870

National Provider Directory

National Provider Directory

Locations

5359 Lyons Rd
Coconut Creek, FL 33073
Phone (954) 397-1452

Practitioners & affiliated clinicians

Practitioners 4

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": "1466553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466553600000",
    "number": "1568813491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5359 LYONS RD",
            "city": "COCONUT CREEK",
            "state": "FL",
            "postal_code": "330732825",
            "telephone_number": "954-570-8870",
            "fax_number": "954-571-6736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5359 LYONS RD",
            "city": "COCONUT CREEK",
            "state": "FL",
            "postal_code": "330732825",
            "telephone_number": "954-570-8870",
            "fax_number": "954-571-6736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY DENTISTRY COSMETIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-22",
        "last_updated": "2016-06-22",
        "status": "A",
        "authorized_official_last_name": "HUTCHISON",
        "authorized_official_first_name": "MANON",
        "authorized_official_middle_name": "BOURQUE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "954-570-8870",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN13436",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN5044",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": "FL",
            "license": "DN19185",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "FL",
            "license": "DN0011990",
            "primary": false
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dental Hygienist",
            "state": "FL",
            "license": "DH15026",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coconut Creek, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2016; 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.