Aquidel Dental Services, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

AQUIDEL DENTAL SERVICES, LLC

Practice address

11574 SW Village Pkwy
Port St Lucie, FL 34987-2392

Phone

(772) 204-3113

NPI assigned

Aug 6, 2022

Organization subpart

No

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

Authorized official

Name

Myrene Myrene

Title

Billing Staff

Phone

(516) 596-8123

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1659744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659744000000",
    "number": "1649907809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11574 SW VILLAGE PKWY",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349872392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11574 SW VILLAGE PKWY",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349872392",
            "telephone_number": "772-204-3113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AQUIDEL DENTAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-06",
        "last_updated": "2022-08-06",
        "certification_date": "2022-08-05",
        "status": "A",
        "authorized_official_last_name": "MYRENE",
        "authorized_official_first_name": "MYRENE",
        "authorized_official_title_or_position": "BILLING STAFF",
        "authorized_official_telephone_number": "516-596-8123"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Providers in Port St Lucie, FL by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2022; 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.