Fishhawk Modern Dentistry, PA

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

FISHHAWK MODERN DENTISTRY, PA

Doing business as

Fishhawk Modern Dentistry

Practice address

16509 Fishhawk Blvd
Lithia, FL 33547-3835

Phone

(813) 563-8108

NPI assigned

Nov 29, 2019

Last updated

Aug 25, 2022By 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

Dr. Katie L McCann Lee, DDS

Title

Owner/GP

Phone

(813) 563-8108

Specialties & licenses 1

Addresses

Other names 1

• Fishhawk Modern Dentistry Doing business as

Locations

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.

• Viktor Pavlidakey, DMD

  • General Practice Dentistry
  • Orange City, FL
  • NPI 1659043214
  NPD (past)

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

{
    "created_epoch": "1574985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661385600000",
    "number": "1730726506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 920050",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753920050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16509 FISHHAWK BLVD",
            "city": "LITHIA",
            "state": "FL",
            "postal_code": "335473835",
            "telephone_number": "813-563-8108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FISHHAWK MODERN DENTISTRY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-29",
        "last_updated": "2022-08-25",
        "certification_date": "2022-08-25",
        "status": "A",
        "authorized_official_last_name": "MCCANN LEE",
        "authorized_official_first_name": "KATIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER/GP",
        "authorized_official_telephone_number": "813-563-8108",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fishhawk Modern Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fishhawk Modern Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Melanie Jane Fielding, RN, LM, RM
• Elisha Findley
• Isaac Fink
• Fishhawk Family Dental
• Fishhawk Family Eyecare
• Fishhawk Oral and Facial Surgery LLC
• Shad Fitzpatrick
• Five Magnolias Assisted Living
• Joshua Fleming
• Florida Autism Center

• Dentist in Lithia, FL
• Providers in Lithia, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2022; 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.