Professional Dental Alliance of Country Walk Ortho, PLLC

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

Legal business name

PROFESSIONAL DENTAL ALLIANCE OF COUNTRY WALK ORTHO, PLLC

Practice address

15795 SW 152ND St
Miami, FL 33187-5417

Phone

(305) 547-8390

NPI assigned

Aug 26, 2019

Organization subpart

No

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

Authorized official

Name

Lauren Howard

Title

Credentialing Specialist

Phone

(757) 576-5479

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1566777600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566777600000",
    "number": "1770130684",
    "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": "15795 SW 152ND ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331875417",
            "telephone_number": "305-547-8390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL DENTAL ALLIANCE OF COUNTRY WALK ORTHO, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-26",
        "last_updated": "2019-08-26",
        "status": "A",
        "authorized_official_last_name": "HOWARD",
        "authorized_official_first_name": "LAUREN",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "757-576-5479"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Professional Care Solution LLC
• Professional Care Therapy, Inc
• Professional Case Management Services Corp
• Professional Choice Inc
• Professional Coaching Advocates LLC
• Professional Dental Alliance of Country Walk, PLLC
• Professional Dental Alliance of West Kendall Ortho, PLLC
• Professional Dental Alliance of West Kendall, PLLC
• Professional Dental Group
• Professional Dental Solutions, Inc

• Orthodontics and Dentofacial Orthopedics Dentistry in Miami, FL
• Providers in Miami, FL by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 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.