NPIMap

Organization Active NPI

Wildwood Dentists, PA

  • General Practice Dentistry
  • Irvine, CA
National Provider Identifier
1770940769
Registry record updated Jun 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
WILDWOOD DENTISTS, PA
Practice address
17000 Red Hill Ave
Irvine, CA 92614-5626
Phone
(714) 845-8890
Fax
(949) 474-1495
NPI assigned
Jan 21, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2016

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

Authorized official

Name
Dr. Katie L McCann, DDS
Title
Owner Dentist
Phone
(352) 418-3041

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

17000 Red Hill Ave
Irvine, CA 92614-5626

Mailing address

4675 E Sr 44
104
Wildwood, FL 34785-7461
Phone (352) 418-3041

Other names 1

  • Wildwood Dentists Doing business as

National Provider Directory

National Provider Directory

Locations

4675 E State Road 44
Ste 104
Wildwood, FL 34785
Phone (352) 418-3041

Practitioners & affiliated clinicians

Practitioners 8

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

NPI Registry JSON

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

{
    "created_epoch": "1453334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465257600000",
    "number": "1770940769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4675 E SR 44",
            "address_2": "104",
            "city": "WILDWOOD",
            "state": "FL",
            "postal_code": "347857461",
            "telephone_number": "352-418-3041",
            "fax_number": "352-250-4141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17000 RED HILL AVE",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926145626",
            "telephone_number": "714-845-8890",
            "fax_number": "949-474-1495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILDWOOD DENTISTS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-21",
        "last_updated": "2016-06-07",
        "status": "A",
        "authorized_official_last_name": "MCCANN",
        "authorized_official_first_name": "KATIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "352-418-3041",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "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": "Wildwood Dentists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Irvine, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 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.