Edward S Mortellaro Jr DMD PA

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DN8061 Issued in FL

Legal business name

EDWARD S MORTELLARO JR DMD PA

Practice address

710 Oakfield Drive
Suite 126
Brandon, FL 33511-4907

Phone

(813) 685-7733

Fax

(813) 681-9726

NPI assigned

Apr 20, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Edward S Mortellaro Jr., DMDNPI 1194068544

Title

President

Phone

(813) 685-7733

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Edward Salvatore Mortellaro Jr., DMD

  • Periodontics
  • Brandon, FL
  • NPI 1194068544
  NPD (past) Authorized official

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

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1770700437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 OAKFIELD DRIVE",
            "address_2": "SUITE 126",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335114907",
            "telephone_number": "813-685-7733",
            "fax_number": "813-681-9726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 OAKFIELD DRIVE",
            "address_2": "SUITE 126",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335114907",
            "telephone_number": "813-685-7733",
            "fax_number": "813-681-9726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDWARD S MORTELLARO JR DMD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MORTELLARO",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "813-685-7733",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "FL",
            "license": "DN8061",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dawn Edmonds
• Lindsay Edmonds
• Gabrielle Edrich
• Brittany M Edsall, RBT
• Edward D Scanlan MD PA
• Eric Justin Edwards, M.D.
• Sierra Edwards
• Stephen Thomas Edwards II, LMFT, BCPC
• Effect Behavioral Health Solutions
• Danielle Eichmann

• Periodontics in Brandon, FL
• Providers in Brandon, FL by specialty
• Periodontics in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.