Professional Dental Alliance of Suntree, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

PROFESSIONAL DENTAL ALLIANCE OF SUNTREE, PLLC

Practice address

7827 N Wickham Rd
Melbourne, FL 32940-8289

Phone

(321) 434-4444

NPI assigned

Aug 13, 2018

Organization subpart

No

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

Authorized official

Name

Annette Marlow

Title

Credentialing Supervisor

Phone

(724) 698-2119

Specialties & licenses 1

Addresses

Other names 1

• New Image Dentistry Suntree Doing business as

Locations

Practitioners 1

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

• Ethan Silverman, DMD

  • General Practice Dentistry
  • Melbourne, FL
  • NPI 1548748999
  NPD (past)

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

{
    "created_epoch": "1534118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534118400000",
    "number": "1669951356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 S MILL ST STE 200",
            "city": "NEW CASTLE",
            "state": "PA",
            "postal_code": "161013680",
            "telephone_number": "724-698-2132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7827 N WICKHAM RD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329408289",
            "telephone_number": "321-434-4444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL DENTAL ALLIANCE OF SUNTREE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-13",
        "last_updated": "2018-08-13",
        "status": "A",
        "authorized_official_last_name": "MARLOW",
        "authorized_official_first_name": "ANNETTE",
        "authorized_official_title_or_position": "CREDENTIALING SUPERVISOR",
        "authorized_official_telephone_number": "724-698-2119"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "New Image Dentistry Suntree",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Christina H. Principe, LMHC
• PRN Home Care, Inc.
• Proactive Counseling Solutions LLC
• Professional Anesthesia Services PA
• Professional Dental Alliance of Lake Washington, PLLC
• Professional Dental Alliance of West Melbourne, PLLC
• Progressive Healthcare of Brevard, LLC
• Project Response, Inc.
• Project Response, Inc.
• Jeff Proos, BCBA

• General Practice Dentistry in Melbourne, FL
• Providers in Melbourne, 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 13, 2018; 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.