Individual provider Active NPI

Robyn Leigh Gagnon, DMD

  • Dentist
  • Tampa, FL
National Provider Identifier
1679986020
Registry record updated Dec 31, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN 20636 Issued in FL
Practice address
14410 Caribbean Breeze Dr
#102
Tampa, FL 33613-5473
Phone
(561) 271-3338
NPI assigned
Jun 3, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DN 20636 FL Primary

Addresses

Primary practice location

14410 Caribbean Breeze Dr
#102
Tampa, FL 33613-5473

Mailing address

5658 Fishhawk Crossing Blvd
Lithia, FL 33547-5900
Phone (561) 271-3338

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160112002438 FL Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 7315249083

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DN 20636FLMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1401753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1451520000000",
    "number": "1679986020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5658 FISHHAWK CROSSING BLVD",
            "city": "LITHIA",
            "state": "FL",
            "postal_code": "335475900",
            "telephone_number": "561-271-3338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14410 CARIBBEAN BREEZE DR",
            "address_2": "#102",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336135473",
            "telephone_number": "561-271-3338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAGNON",
        "first_name": "ROBYN",
        "middle_name": "LEIGH",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-03",
        "last_updated": "2015-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN 20636",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.