NPIMap

Organization Active NPI

Pediatric and Family Dental Group LLC

  • Pediatric Dentistry
  • Orlando, FL
National Provider Identifier
1710388269
Registry record updated Jul 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
DN17111 Issued in FL
Legal business name
PEDIATRIC AND FAMILY DENTAL GROUP LLC
Practice address
6161 Winegard Rd
Orlando, FL 32809-4977
Phone
(407) 749-0113
Fax
(407) 786-5878
NPI assigned
Sep 15, 2014
Last updated
Jul 28, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2015

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

Authorized official

Name
Ms. Jocelyn Espejo
Title
Practice Manager
Phone
(407) 737-7767

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DN19618 FL
Dentist 122300000X DN20790 FL
Pediatric Dentistry 1223P0221X DN18209 FL
Pediatric Dentistry 1223P0221X DN17111 FL Primary

Addresses

Primary practice location

6161 Winegard Rd
Orlando, FL 32809-4977

Mailing address

PO Box 590710
Orlando, FL 32859-0710
Phone (407) 749-0113

National Provider Directory

National Provider Directory

Locations

6161 Winegard Rd
Orlando, FL 32809
Phone (407) 749-0113

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": "1410739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438041600000",
    "number": "1710388269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 590710",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328590710",
            "telephone_number": "407-749-0113",
            "fax_number": "407-786-5878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6161 WINEGARD RD",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328094977",
            "telephone_number": "407-749-0113",
            "fax_number": "407-786-5878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC AND FAMILY DENTAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-15",
        "last_updated": "2015-07-28",
        "status": "A",
        "authorized_official_last_name": "ESPEJO",
        "authorized_official_first_name": "JOCELYN",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "407-737-7767",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN19618",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN20790",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "FL",
            "license": "DN18209",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "FL",
            "license": "DN17111",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2015; 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.