NPIMap

Organization Active NPI

Florida Dental Professionals, P.a.

  • General Practice Dentistry
  • St Petersburg, FL
National Provider Identifier
1811548407
Registry record updated Nov 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
FLORIDA DENTAL PROFESSIONALS, P.A.
Practice address
390 4TH St N Ste 101
St Petersburg, FL 33701-2802
Phone
(737) 282-1980
NPI assigned
Sep 25, 2019
Organization subpart
Yes
Parent organization
FLORIDA DENTAL PROFESSIONALS, P.A.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 9, 2020

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

Authorized official

Name
Tabatha Lemke
Title
Credentialing Coordinator
Phone
(217) 540-6078

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

390 4TH St N Ste 101
St Petersburg, FL 33701-2802

Mailing address

390 4TH St N Ste 101
St Petersburg, FL 33701-2802

Other names 1

  • Esthetic & Integrative Dentistry Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Florida Dental Professionals PA13 organizations share this tax ID, including this one
Part of
Florida Dental Professionals PA

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Locations

390 4th St N
Ste 101
St Petersburg, FL 33701
Phone (727) 282-1980

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1569369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604880000000",
    "number": "1811548407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "390 4TH ST N STE 101",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337012802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "390 4TH ST N STE 101",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337012802",
            "telephone_number": "737-282-1980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA DENTAL PROFESSIONALS, P.A.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FLORIDA DENTAL PROFESSIONALS, P.A.",
        "enumeration_date": "2019-09-25",
        "last_updated": "2020-11-09",
        "certification_date": "2020-11-09",
        "status": "A",
        "authorized_official_last_name": "LEMKE",
        "authorized_official_first_name": "TABATHA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-6078"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Esthetic & Integrative Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Petersburg, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 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.