Organization Active NPI

Dental Associates of Winter Haven

  • General Practice Dentistry
  • Lakeland, FL
National Provider Identifier
1578830147
Registry record updated Nov 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN17074 Issued in FL
Legal business name
DENTAL ASSOCIATES OF WINTER HAVEN
Practice address
3500 S Florida Ave
Suite 2
Lakeland, FL 33803-4869
Phone
(863) 510-5960
Fax
(863) 510-5961
NPI assigned
Nov 25, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2011

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

Authorized official

Name
Bill Witt
Title
Operations Manager
Phone
(863) 510-5960

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X DN17074 FL Primary

Addresses

Primary practice location

3500 S Florida Ave
Suite 2
Lakeland, FL 33803-4869

Mailing address

317 Cypress Gardens Blvd
Winter Haven, FL 33880-4452
Phone (863) 875-7934

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1322179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322179200000",
    "number": "1578830147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "317 CYPRESS GARDENS BLVD",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338804452",
            "telephone_number": "863-875-7934",
            "fax_number": "863-875-7938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 S FLORIDA AVE",
            "address_2": "SUITE 2",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338034869",
            "telephone_number": "863-510-5960",
            "fax_number": "863-510-5961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL ASSOCIATES OF WINTER HAVEN",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-25",
        "last_updated": "2011-11-25",
        "status": "A",
        "authorized_official_last_name": "WITT",
        "authorized_official_first_name": "BILL",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "863-510-5960"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN17074",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeland, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2011; 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.