Active NPI
Amber Lynn Medellin, DMD
- General Practice Dentistry
- Orlando, FL
National Provider Identifier
1720601628
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN24862
- Practice address
- 8801 Commodity Cir
Orlando, FL 32819-9053 - Phone
- (407) 248-0100
- NPI assigned
- May 26, 2020
- 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 | DN24862 | FL | Primary |
Addresses
Primary practice location
8801 Commodity Cir
Orlando, FL 32819-9053
Mailing address
8801 Commodity Cir
Orlando, FL 32819-9053
Phone (407) 248-0100
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 |
|---|---|---|---|
| DN24862 | FL | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southpark Dental Group | General Practice | Past | Accepting new patients |
Networks
- Freedom Health HMO Network
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1590451200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1607644800000",
"number": "1720601628",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8801 COMMODITY CIR",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328199053",
"telephone_number": "407-248-0100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8801 COMMODITY CIR",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328199053",
"telephone_number": "407-248-0100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDELLIN",
"first_name": "AMBER",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-05-26",
"last_updated": "2020-12-11",
"certification_date": "2020-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist, General Practice",
"state": "FL",
"license": "DN24862",
"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 Dec 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.