Banyan Dental SVC PSL, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN16485 Issued in FL

Legal business name

BANYAN DENTAL SVC PSL, LLC

Practice address

1707 NW St. Lucie W. Blvd
#126
Port Saint Lucie, FL 34986

Phone

(772) 344-3300

Fax

(772) 344-3301

NPI assigned

Feb 3, 2014

Organization subpart

No

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

Authorized official

Name

Jade E. Thomas, DDS

Title

Owner

Phone

(772) 344-3300

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1391385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391385600000",
    "number": "1740603380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1707 NW ST. LUCIE W. BLVD",
            "address_2": "#126",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "34986",
            "telephone_number": "772-344-3300",
            "fax_number": "772-344-3301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1707 NW ST. LUCIE W. BLVD",
            "address_2": "#126",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "34986",
            "telephone_number": "772-344-3300",
            "fax_number": "772-344-3301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BANYAN DENTAL SVC PSL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-03",
        "last_updated": "2014-02-03",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "JADE",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "772-344-3300",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN16485",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Juliana Baker, RBT
• Fady Bakhet
• Ryan Baksh, PTA
• Alice Darlene Bancroft, LCSW
• Viven Banks
• Jason Barela
• Matilde Teresa Barksdale
• Shelby Lynn Baron, DO
• Ernesto Barral, M.D.
• Natajah Barrett, EKG

• General Practice Dentistry in Port Saint Lucie, FL
• Providers in Port Saint Lucie, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2014; 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.