Individual provider Active NPI

Clement James Contestable, DMD

  • General Practice Dentistry
  • Orlando, FL
National Provider Identifier
1811208853
Registry record updated Apr 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN19066 Issued in FL
Practice address
4307 E Colonial Dr
Orlando, FL 32803-5217
Phone
(407) 362-7705
NPI assigned
Jun 24, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DN19066 FL Primary

Addresses

Primary practice location

4307 E Colonial Dr
Orlando, FL 32803-5217

Mailing address

100 S Eola Dr Unit 508
Orlando, FL 32801-2892
Phone (321) 356-5497

Other practice location 1

1941 Salk Ave
Tavares, FL 32778-4306
Phone (352) 357-4588

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160224000366 FL Order and Referring Only - DentistPractitioner - Dentist 6608171947

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DN19066FLMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Dentistry at Town Park LLC General Practice CurrentSince Apr 30, 2023 Accepting new patients
Dentistry of Tavares CurrentSince Dec 12, 2021 Accepting new patients

Locations

4307 E Colonial Dr
Orlando, FL 32803
Phone (407) 362-7705

1941 Salk Ave
Tavares, FL 32778
Phone (321) 356-5497

Networks

  • Freedom Health HMO Network

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1277337600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682380800000",
    "number": "1811208853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 S EOLA DR UNIT 508",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328012892",
            "telephone_number": "321-356-5497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4307 E COLONIAL DR",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328035217",
            "telephone_number": "407-362-7705"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1941 Salk Ave",
            "address_purpose": "LOCATION",
            "city": "Tavares",
            "state": "FL",
            "postal_code": "327784306",
            "country_code": "US",
            "telephone_number": "352-357-4588",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CONTESTABLE",
        "first_name": "CLEMENT",
        "middle_name": "JAMES",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-24",
        "last_updated": "2023-04-25",
        "certification_date": "2023-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN19066",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.