Main Street Childrens Dentistry and Orthodontics of Lakewood Ranch PLL

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

Legal business name

MAIN STREET CHILDRENS DENTISTRY AND ORTHODONTICS OF LAKEWOOD RANCH PLL

Practice address

11649 Sr 70 East, Suite 109
Bradenton, FL 34202

Phone

(941) 209-1213

NPI assigned

May 1, 2018

Last updated

May 1, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Stephanie Gomez

Title

Credentialing Supervisor

Phone

(305) 274-2499

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1525132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525132800000",
    "number": "1790273159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6240 LAKE OSPREY DR DEPT 50226",
            "city": "LAKEWOOD RANCH",
            "state": "FL",
            "postal_code": "342408421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11649 SR 70 EAST, SUITE 109",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "34202",
            "telephone_number": "941-209-1213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET CHILDRENS DENTISTRY AND ORTHODONTICS OF LAKEWOOD RANCH PLL",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-01",
        "last_updated": "2018-05-01",
        "status": "A",
        "authorized_official_last_name": "GOMEZ",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "CREDENTIALING SUPERVISOR",
        "authorized_official_telephone_number": "305-274-2499"
    },
    "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": []
}

• Alexa L. Magner, M.D
• Jennifer Maguire
• Adena Andrea Mahadai
• Angela Lorraine Mahan, MA-CCC-SLP
• Flora R Mahiquez, RPH
• Deborah Majchel Koss, M.D.
• Deepa Manik Makhijani, M.D.
• Nancy J. Malachowski, BA
• Dianne Malave
• Orlando Maldonado, M.D.

• Orthodontics and Dentofacial Orthopedics Dentistry in Bradenton, FL
• Providers in Bradenton, 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 May 1, 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.