Jose Manuel Divo Materan

Primary specialty

DentistTaxonomy code 122300000X

License

DN31027 Issued in FL

Practice address

12329 S Orange Blossom TRL
Orlando, FL 32837-6214

Phone

(407) 584-8565

NPI assigned

Jan 28, 2025

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Networks

• Freedom Health HMO Network

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.

• West Coast Dental Partners

  • General Practice Dentistry
  • Orlando, FL
  • NPI 1699649061
  NPD

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

{
    "created_epoch": "1738022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761782400000",
    "number": "1811700610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "932 LARSON DR",
            "city": "ALTAMONTE SPRINGS",
            "state": "FL",
            "postal_code": "327142036",
            "telephone_number": "407-848-6760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12329 S ORANGE BLOSSOM TRL",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328376214",
            "telephone_number": "407-584-8565"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "635 Albany St",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021183550",
            "country_code": "US",
            "telephone_number": "617-358-8300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DIVO MATERAN",
        "first_name": "JOSE",
        "middle_name": "MANUEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-01-28",
        "last_updated": "2025-10-30",
        "certification_date": "2025-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MA",
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN31027",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Divine Hope Home Care LLC
• Divine Individuals Counseling Services, Inc.
• Divine Phlebotomy Training
• Divinely Purposed Care LLC
• Katherine Marie Divino, MD
• Danielle Dixon-Brown
• Ashley Dixon, MD
• Brandi Dixon
• Christina Dixon, P.A.-C
• Christopher Luke Dixon, MD

• Dentist in Orlando, FL
• Providers in Orlando, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2025; 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.