NPIMap

Organization Active NPI

Main Street Children's Dentistry and Orthodontics of Wellington, PA

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Royal Palm Beach, FL
National Provider Identifier
1760687149
Registry record updated Aug 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
Legal business name
MAIN STREET CHILDREN'S DENTISTRY AND ORTHODONTICS OF WELLINGTON, PA
Practice address
11903 Southern Blvd.
Suite #102
Royal Palm Beach, FL 33411
Phone
(561) 422-2940
Fax
(561) 422-2945
NPI assigned
Jun 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2014

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

Authorized official

Name
Stephanie Gomez
Title
Provider Relations
Phone
(305) 274-2499

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223X0400X FL Primary

Addresses

Primary practice location

11903 Southern Blvd.
Suite #102
Royal Palm Beach, FL 33411

Mailing address

13195 SW 134 St
2ND Floor
Miami, FL 33186
Phone (305) 274-2499

National Provider Directory

National Provider Directory
Tax ID family
Main Street Children's Dentistry of Wellington3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1182124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1408492800000",
    "number": "1760687149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13195 SW 134 ST",
            "address_2": "2ND FLOOR",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "33186",
            "telephone_number": "305-274-2499",
            "fax_number": "561-422-2945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11903 SOUTHERN BLVD.",
            "address_2": "SUITE #102",
            "city": "ROYAL PALM BEACH",
            "state": "FL",
            "postal_code": "33411",
            "telephone_number": "561-422-2940",
            "fax_number": "561-422-2945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET CHILDREN'S DENTISTRY AND ORTHODONTICS OF WELLINGTON, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-18",
        "last_updated": "2014-08-20",
        "status": "A",
        "authorized_official_last_name": "GOMEZ",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "PROVIDER RELATIONS",
        "authorized_official_telephone_number": "305-274-2499"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Royal Palm Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 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.