NPIMap

Organization Active NPI

Park Boulevard Family Dentistry

  • Dentist
  • Pinellas Park, FL
National Provider Identifier
1578170684
Registry record updated Sep 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
PARK BOULEVARD FAMILY DENTISTRY
Practice address
4326 Park Blvd N Ste a
Pinellas Park, FL 33781-3538
Phone
(727) 291-0220
NPI assigned
Sep 24, 2020
Last updated
Sep 24, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2020

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

Authorized official

Name
Brianne Leigh Wade, DMDNPI 1801249412
Title
Owner/President/Dentist
Phone
(813) 244-6045

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NU Primary

Addresses

Primary practice location

4326 Park Blvd N Ste a
Pinellas Park, FL 33781-3538

Mailing address

4326 Park Blvd N Ste a
Pinellas Park, FL 33781-3538
Phone (727) 291-0220

National Provider Directory

National Provider Directory

Locations

4326 Park Blvd N
Ste A
Pinellas Park, FL 33781
Phone (727) 291-0220

Practitioners & affiliated clinicians

Practitioners 1

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": "1600905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600905600000",
    "number": "1578170684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4326 PARK BLVD N STE A",
            "city": "PINELLAS PARK",
            "state": "FL",
            "postal_code": "337813538",
            "telephone_number": "727-291-0220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4326 PARK BLVD N STE A",
            "city": "PINELLAS PARK",
            "state": "FL",
            "postal_code": "337813538",
            "telephone_number": "727-291-0220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK BOULEVARD FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-24",
        "last_updated": "2020-09-24",
        "certification_date": "2020-09-23",
        "status": "A",
        "authorized_official_last_name": "WADE",
        "authorized_official_first_name": "BRIANNE",
        "authorized_official_middle_name": "LEIGH",
        "authorized_official_title_or_position": "OWNER/PRESIDENT/DENTIST",
        "authorized_official_telephone_number": "813-244-6045",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pinellas Park, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2020; 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.