Professional Dental Alliance of Palm Bay, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

PROFESSIONAL DENTAL ALLIANCE OF PALM BAY, PLLC

Doing business as

Palm Bay Dental Center

Practice address

1764 Palm Bay Rd NE
Palm Bay, FL 32905-2904

Phone

(321) 725-5512

NPI assigned

Aug 13, 2018

Organization subpart

No

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

Authorized official

Name

Annette Marlow

Title

Credentialing Supervisor

Phone

(321) 725-5512

Specialties & licenses 1

Addresses

Other names 1

• Palm Bay Dental Center Doing business as

Locations

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

{
    "created_epoch": "1534118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534118400000",
    "number": "1770062465",
    "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",
            "telephone_number": "724-698-2132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1764 PALM BAY RD NE",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329052904",
            "telephone_number": "321-725-5512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL DENTAL ALLIANCE OF PALM BAY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-13",
        "last_updated": "2018-08-13",
        "status": "A",
        "authorized_official_last_name": "MARLOW",
        "authorized_official_first_name": "ANNETTE",
        "authorized_official_title_or_position": "CREDENTIALING SUPERVISOR",
        "authorized_official_telephone_number": "321-725-5512"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Palm Bay Dental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Palm Bay, FL
• Providers in Palm Bay, 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 Aug 13, 2018; 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.