NPIMap

Organization Active NPI

Advanced Dental Inc.

  • Dentist
  • Port Orange, FL
National Provider Identifier
1669503264
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN12614 Issued in FL
Legal business name
ADVANCED DENTAL INC.
Practice address
1525 Herbert St
Suite 101
Port Orange, FL 32129-6106
Phone
(386) 322-7786
Fax
(386) 761-3920
NPI assigned
Mar 8, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Luis O. Soto, D.M.D.
Title
President
Phone
(386) 322-7786

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X DN12614 FL Primary

Addresses

Primary practice location

1525 Herbert St
Suite 101
Port Orange, FL 32129-6106

Mailing address

1525 Herbert St
Suite 101
Port Orange, FL 32129-6106
Phone (386) 322-7786

Other names 1

  • Advanced Dental Care Doing business as

National Provider Directory

National Provider Directory

Locations

1525 Herbert St
Ste 101
Port Orange, FL 32129
Phone (386) 322-7786

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1669503264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1525 HERBERT ST",
            "address_2": "SUITE 101",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321296106",
            "telephone_number": "386-322-7786",
            "fax_number": "386-761-3920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 HERBERT ST",
            "address_2": "SUITE 101",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321296106",
            "telephone_number": "386-322-7786",
            "fax_number": "386-761-3920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DENTAL INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SOTO",
        "authorized_official_first_name": "LUIS",
        "authorized_official_middle_name": "O.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "386-322-7786",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN12614",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Orange, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.