Serenity Grove Dental PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

SERENITY GROVE DENTAL PLLC

Practice address

13475 Southern Blvd
Suite 201
Loxahatchee, FL 33470

Phone

(561) 318-0805

NPI assigned

May 7, 2024

Organization subpart

No

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

Authorized official

Name

Tatyana Prosolupova, DDSNPI 1992315998

Title

Ceo

Phone

(561) 318-0805

Specialties & licenses 1

Addresses

Locations

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.

• Tatyana Prosolupova

  • General Practice Dentistry
  • Torrance, CA
  • NPI 1992315998
  NPD Authorized official

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

{
    "created_epoch": "1715040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718064000000",
    "number": "1598513327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1331 DUVAL ST",
            "city": "JUPITER",
            "state": "FL",
            "postal_code": "334588761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13475 SOUTHERN BLVD",
            "address_2": "SUITE 201",
            "city": "LOXAHATCHEE",
            "state": "FL",
            "postal_code": "33470",
            "telephone_number": "561-318-0805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERENITY GROVE DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-07",
        "last_updated": "2024-06-11",
        "certification_date": "2024-06-11",
        "status": "A",
        "authorized_official_last_name": "PROSOLUPOVA",
        "authorized_official_first_name": "TATYANA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "561-318-0805",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michaela Schuette, LCSW
• Christine Marie Schuler
• Delvis Secin Santana, MD
• Ali Sedagheh Pakravan, M.D.
• Maria Sepulveda, NP
• Matthew Raymond Shandy, MD
• Holly Kristen Shaw, PT
• Scoey Lewis Shephard
• Sheridan Healthcorp Inc
• Sheridan Healthcorp Inc

• Dental Clinic/Center in Loxahatchee, FL
• Providers in Loxahatchee, FL by specialty
• Dental Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2024; 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.