Dentist at the Villages

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

License

DN 15845 Issued in FL

Legal business name

DENTIST AT THE VILLAGES

Practice address

307 Lagrande Blvd
Lady Lake, FL 32159-2388

Phone

(352) 753-5789

NPI assigned

Aug 28, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Carlos Medina, DMD

Title

Ownwe/Dentist

Phone

(352) 753-5789

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1472342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472342400000",
    "number": "1760938005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 LAGRANDE BLVD",
            "city": "LADY LAKE",
            "state": "FL",
            "postal_code": "321592388",
            "telephone_number": "352-753-5789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 LAGRANDE BLVD",
            "city": "LADY LAKE",
            "state": "FL",
            "postal_code": "321592388",
            "telephone_number": "352-753-5789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTIST AT THE VILLAGES",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-28",
        "last_updated": "2016-08-28",
        "status": "A",
        "authorized_official_last_name": "MEDINA",
        "authorized_official_first_name": "CARLOS",
        "authorized_official_title_or_position": "OWNWE/DENTIST",
        "authorized_official_telephone_number": "352-753-5789",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "FL",
            "license": "DN 15845",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Lady Lake, FL
• Exclusive Provider Organization in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2016; 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.