NPIMap

Organization Active NPI

Kreative Dental Care PA

  • Dental Clinic/Center
  • Polk City, FL
National Provider Identifier
1861967333
Registry record updated Oct 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
KREATIVE DENTAL CARE PA
Practice address
120 Carter Blvd Ste 7
Polk City, FL 33868-8912
Phone
(863) 984-0000
NPI assigned
Oct 10, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2018

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

Authorized official

Name
Dr. Yalice Mariely Cardona, DMDNPI 1336317353
Title
President
Phone
(787) 552-2631

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

120 Carter Blvd Ste 7
Polk City, FL 33868-8912

Mailing address

120 Carter Blvd Ste 7
Polk City, FL 33868-8912
Phone (863) 984-0000

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1539129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539129600000",
    "number": "1861967333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 CARTER BLVD STE 7",
            "city": "POLK CITY",
            "state": "FL",
            "postal_code": "338688912",
            "telephone_number": "863-984-0000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 CARTER BLVD STE 7",
            "city": "POLK CITY",
            "state": "FL",
            "postal_code": "338688912",
            "telephone_number": "863-984-0000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KREATIVE DENTAL CARE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-10",
        "last_updated": "2018-10-10",
        "status": "A",
        "authorized_official_last_name": "CARDONA",
        "authorized_official_first_name": "YALICE",
        "authorized_official_middle_name": "MARIELY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "787-552-2631",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Polk City, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2018; 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.