Orthodontic Professional Services

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

DN20300 Issued in FL

Legal business name

ORTHODONTIC PROFESSIONAL SERVICES

Practice address

1813 SE Port St Lucie Blvd
Port St Lucie, FL 34952-5544

Phone

(772) 528-3434

NPI assigned

Mar 26, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Marcela Matamoros, DMD

Title

President

Phone

(772) 528-3434

Specialties & licenses 1

Addresses

Other names 1

• ION Orthodontics Doing business as

Locations

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

{
    "created_epoch": "1522022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522022400000",
    "number": "1669977203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1813 SE PORT ST LUCIE BLVD",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349525544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1813 SE PORT ST LUCIE BLVD",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349525544",
            "telephone_number": "772-528-3434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHODONTIC PROFESSIONAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-26",
        "last_updated": "2018-03-26",
        "status": "A",
        "authorized_official_last_name": "MATAMOROS",
        "authorized_official_first_name": "MARCELA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "772-528-3434",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "FL",
            "license": "DN20300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ION Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gonzalo A Oria, MD
• Nicole Orozco
• Nicole Ortega Figueroa
• Daylis Ortega Lluch
• Ortho Florida, LLC
• Orthotic & Prosthetic Centers, Inc.
• Orthotic & Prosthetic Clinic Inc
• Kiomary Ortiz Aponte
• Sara Maria Ortiz Cabrales, RBT
• Trina Ortiz-Hughes, FNP-C

• Orthodontics and Dentofacial Orthopedics Dentistry in Port St Lucie, FL
• Providers in Port St Lucie, FL by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 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.