Charlotte Family Dentistry LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN16793 Issued in FL

Legal business name

CHARLOTTE FAMILY DENTISTRY LLC

Practice address

18000 Toledo Blade Blvd
Port Charlotte, FL 33948-1980

Phone

(941) 624-4000

Fax

(941) 624-2208

NPI assigned

Aug 3, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Dean J Mourselas, DDS

Title

Managing Member

Phone

(941) 624-4000

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1470182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470182400000",
    "number": "1639622988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18000 TOLEDO BLADE BLVD",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339481980",
            "telephone_number": "941-624-4000",
            "fax_number": "941-624-2208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18000 TOLEDO BLADE BLVD",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339481980",
            "telephone_number": "941-624-4000",
            "fax_number": "941-624-2208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLOTTE FAMILY DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-03",
        "last_updated": "2016-08-03",
        "status": "A",
        "authorized_official_last_name": "MOURSELAS",
        "authorized_official_first_name": "DEAN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "941-624-4000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN16793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Port Charlotte, FL
• Providers in Port Charlotte, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 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.