NPIMap

Organization Active NPI

Imagine Orthodontic Studio PLLC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Lakeland, FL
National Provider Identifier
1700411857
Registry record updated May 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
Legal business name
IMAGINE ORTHODONTIC STUDIO PLLC
Practice address
3595 S Florida Ave
Lakeland, FL 33803-4860
Phone
(727) 743-8307
NPI assigned
Mar 10, 2020
Last updated
May 11, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2020

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

Authorized official

Name
Paiyal PopatNPI 1811427727
Title
Owner
Phone
(407) 758-5424

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223X0400X Primary

Addresses

Primary practice location

3595 S Florida Ave
Lakeland, FL 33803-4860

Mailing address

3595 S Florida Ave
Lakeland, FL 33803-4860

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL Lakeland

National Provider Directory

National Provider Directory
Tax ID family
Imagine Orthodontic Studio PLLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3595 S Florida Ave
Lakeland, FL 33803
Phone (727) 743-8307

Practitioners & affiliated clinicians

Practitioners 1

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": "1583798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589155200000",
    "number": "1700411857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3595 S FLORIDA AVE",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338034860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3595 S FLORIDA AVE",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338034860",
            "telephone_number": "727-743-8307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMAGINE ORTHODONTIC STUDIO PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-10",
        "last_updated": "2020-05-11",
        "certification_date": "2020-05-11",
        "status": "A",
        "authorized_official_last_name": "POPAT",
        "authorized_official_first_name": "PAIYAL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "407-758-5424"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Lakeland",
            "affiliation": "N",
            "address_1": "3595 S Florida Ave",
            "city": "Lakeland",
            "state": "FL",
            "country_code": "US",
            "postal_code": "338034860",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lakeland, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2020; 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.