Professional Dental Alliance of Beachside, PLLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

PROFESSIONAL DENTAL ALLIANCE OF BEACHSIDE, PLLC

Practice address

660 E Eau Gallie Blvd Ste 1
Indian Harbour Beach, FL 32937-4252

Phone

(321) 777-7474

Fax

(321) 777-7558

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 Beachside Doing business as

Practitioners 2

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

• Sowmya Rao Kumar, DMD

  • General Practice Dentistry
  • Rockledge, FL
  • NPI 1316354467
  NPD (past)
• Sumayya Mujeeb, DMD

  • General Practice Dentistry
  • Indian Harbour Beach, FL
  • NPI 1750908422
  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": "1669951489",
    "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": "724-698-2500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "660 E EAU GALLIE BLVD STE 1",
            "city": "INDIAN HARBOUR BEACH",
            "state": "FL",
            "postal_code": "329374252",
            "telephone_number": "321-777-7474",
            "fax_number": "321-777-7558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL DENTAL ALLIANCE OF BEACHSIDE, 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": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "New Image Dentistry Beachside",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Teresa Anne Petzar, PTA
• Stephen Piakis, LDO
• Brian Kelly Pogue, DPT
• Kevin Poulston, DC
• Kelly A. Prete
• Kimberly J Prough, PAC
• Publix Super Markets Inc
• William Quinn, LMT
• Allysen Rainier, PT, DPT
• Jessica Diane Rassmann, PT, DPT

• Dentist in Indian Harbour Beach, FL
• Providers in Indian Harbour Beach, FL by specialty
• Dentist 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.