Kissimmee Modern Dentistry, PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

KISSIMMEE MODERN DENTISTRY, PA

Practice address

4396 W Vine St
Kissimmee, FL 34746

Phone

(407) 232-6187

NPI assigned

Jun 20, 2025

Last updated

May 13, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Brooke Kovinsky

Title

Owner

Phone

(714) 845-8500

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1750377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778630400000",
    "number": "1730076969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 660041",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752660041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4396 W VINE ST",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "34746",
            "telephone_number": "407-232-6187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KISSIMMEE MODERN DENTISTRY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-06-20",
        "last_updated": "2026-05-13",
        "certification_date": "2026-05-13",
        "status": "A",
        "authorized_official_last_name": "KOVINSKY",
        "authorized_official_first_name": "BROOKE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "714-845-8500"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Kissimmee, FL
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2026; 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.