Phuong Helene Ta, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN14668 Issued in FL

Practice address

36800 Winfield CT
Grand Island, FL 32735-9131

Phone

(352) 255-5538

NPI assigned

Dec 19, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Buenos Aires Dental, Inc

  • General Practice Dentistry
  • The Villages, FL
  • NPI 1467691212
  NPD (past)

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430956800000",
    "number": "1811050917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1503 BUENOS AIRES BLVD STE 125",
            "city": "LADY LAKE",
            "state": "FL",
            "postal_code": "321596826",
            "telephone_number": "352-753-5838",
            "fax_number": "352-391-5837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36800 WINFIELD CT",
            "city": "GRAND ISLAND",
            "state": "FL",
            "postal_code": "327359131",
            "telephone_number": "352-255-5538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TA",
        "first_name": "PHUONG",
        "middle_name": "HELENE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-19",
        "last_updated": "2015-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN14668",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Farronda Peterson
• Peterson'S Care at Hand
• Kevin Roberts, FNP-C
• Serenitude Bloom, LLC
• Porche Simmons
• Jamie Tamayo
• Angela Masoline Thomas
• Ruth Wallace-Williams
• America Monique Weatherspoon

• General Practice Dentistry in Grand Island, FL
• Providers in Grand Island, 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 May 7, 2015; 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.