Professional Dental Alliance of PRT St Lucie Prma Vsta, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

PROFESSIONAL DENTAL ALLIANCE OF PRT ST LUCIE PRMA VSTA, PLLC

Practice address

499 NW Prima Vista Blvd Unit 107
Port St Lucie, FL 34983-8786

Phone

(772) 336-1500

NPI assigned

May 23, 2019

Organization subpart

No

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

Authorized official

Name

Jessica Barrette

Title

Credentialing Specialist

Phone

(724) 698-2997

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1558569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1558569600000",
    "number": "1750948907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 S MILL ST STE 200",
            "city": "NEW CASTLE",
            "state": "PA",
            "postal_code": "161013680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "499 NW PRIMA VISTA BLVD UNIT 107",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349838786",
            "telephone_number": "772-336-1500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL DENTAL ALLIANCE OF PRT ST LUCIE PRMA VSTA, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-23",
        "last_updated": "2019-05-23",
        "status": "A",
        "authorized_official_last_name": "BARRETTE",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "724-698-2997"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Esnel Principal
• Jennifer K Principato, LMT
• Jo-Ann Prisco, LMHC
• Matthew W Pritikin, PMHNP-BC
• Professional Dental Alliance of Florida, PLLC
• Professional Dental Alliance of PRT St Lucie St Lucie, PLLC
• Project Lifesaver Inc
• Project Lifesaver Inc
• Mischa N Prophete
• Proseniors Home Health Services Inc

• General Practice Dentistry in Port St Lucie, FL
• Providers in Port St 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 May 23, 2019; 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.