NPIMap

Organization Active NPI

Prime Pediatric Dental Group PA

  • Pediatric Dentistry
  • Palm Springs, FL
National Provider Identifier
1811713019
Registry record updated Dec 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
PRIME PEDIATRIC DENTAL GROUP PA
Practice address
3401 S Congress Ave Ste 206
Palm Springs, FL 33461-3066
Phone
(305) 251-5390
NPI assigned
Dec 3, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2024

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

Authorized official

Name
Dr. Jose Mellado
Title
President
Phone
(305) 321-3790

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X Primary

Addresses

Primary practice location

3401 S Congress Ave Ste 206
Palm Springs, FL 33461-3066

Mailing address

13757 SW 152ND St
Miami, FL 33177-8125
Phone (305) 251-5390

National Provider Directory

National Provider Directory
Tax ID family
Prime Pediatric Dental Group PA6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

NPI Registry JSON

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

{
    "created_epoch": "1733184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733184000000",
    "number": "1811713019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13757 SW 152ND ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331778125",
            "telephone_number": "305-251-5390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 S CONGRESS AVE STE 206",
            "city": "PALM SPRINGS",
            "state": "FL",
            "postal_code": "334613066",
            "telephone_number": "305-251-5390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME PEDIATRIC DENTAL GROUP PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-03",
        "last_updated": "2024-12-03",
        "certification_date": "2024-12-03",
        "status": "A",
        "authorized_official_last_name": "MELLADO",
        "authorized_official_first_name": "JOSE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "305-321-3790",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Springs, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2024; 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.