Active NPI
Mary Lynn Licht, D.D.S., D.M.D.
- General Practice Dentistry
- Wellington, FL
National Provider Identifier
1679790257
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 9660
- Practice address
- 11924 W Forest Hill Blvd Ste 10
Wellington, FL 33414-6200 - Phone
- (561) 798-0825
- Fax
- (561) 795-9909
- NPI assigned
- Apr 18, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 9660 | FL | Primary |
Addresses
Primary practice location
11924 W Forest Hill Blvd Ste 10
Wellington, FL 33414-6200
Mailing address
2284 Alford Way
Wellington, FL 33414-6200
Phone (561) 798-0825
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 576405 | Other | FL | UNITED CONCORDIA |
| 67438 | Other | FL | B.C.B.S. OF FLA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9660 | FL | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176854400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1679790257",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2284 ALFORD WAY",
"city": "WELLINGTON",
"state": "FL",
"postal_code": "334146200",
"telephone_number": "561-798-0825",
"fax_number": "561-795-9909"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11924 W FOREST HILL BLVD STE 10",
"city": "WELLINGTON",
"state": "FL",
"postal_code": "334146200",
"telephone_number": "561-798-0825",
"fax_number": "561-795-9909"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LICHT",
"first_name": "MARY",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "D.D.S., D.M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "FL",
"license": "9660",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "576405",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "B.C.B.S. OF FLA",
"identifier": "67438",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wellington, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.