NPIMap

Organization Active NPI

Key West Dental Management Group LLC

Doing business as Key West Dental

  • Dental Clinic/Center
  • Key West, FL
National Provider Identifier
1699446633
Registry record updated Sep 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
KEY WEST DENTAL MANAGEMENT GROUP LLC
Doing business as
Key West Dental
Practice address
1215 Simonton St
Key West, FL 33040-3158
Phone
(305) 296-8541
NPI assigned
Sep 21, 2021
Last updated
Sep 21, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2021

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

Authorized official

Name
Mrs. Isis Sampedro
Title
C.O.O
Phone
(786) 226-7474

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Endodontics 1223E0200X NU
General Practice Dentistry 1223G0001X NU
Oral and Maxillofacial Surgery (Dentist) 1223S0112X NU
Dental Clinic/Center 261QD0000X NU Primary

Addresses

Primary practice location

1215 Simonton St
Key West, FL 33040-3158

Mailing address

1215 Simonton St
Key West, FL 33040-3158
Phone (305) 296-8541

Other identifiers 1

IdentifierTypeStateIssuer
024079200MedicaidFL

Other names 1

  • Key West Dental Doing business as

National Provider Directory

National Provider Directory

Locations

1215 Simonton St
Key West, FL 33040
Phone (305) 296-3541

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1632182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632182400000",
    "number": "1699446633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 SIMONTON ST",
            "city": "KEY WEST",
            "state": "FL",
            "postal_code": "330403158",
            "telephone_number": "305-296-8541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 SIMONTON ST",
            "city": "KEY WEST",
            "state": "FL",
            "postal_code": "330403158",
            "telephone_number": "305-296-8541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEY WEST DENTAL MANAGEMENT GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-21",
        "last_updated": "2021-09-21",
        "certification_date": "2021-09-21",
        "status": "A",
        "authorized_official_last_name": "SAMPEDRO",
        "authorized_official_first_name": "ISIS",
        "authorized_official_title_or_position": "C.O.O",
        "authorized_official_telephone_number": "786-226-7474",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "024079200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Key West Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Key West, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2021; 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.