NPIMap

Organization Active NPI

Dentists of Melbourne, PA

Doing business as Dentists of Melbourne

  • Dentist
  • Melbourne, FL
National Provider Identifier
1871006742
Registry record updated Dec 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
DENTISTS OF MELBOURNE, PA
Doing business as
Dentists of Melbourne
Practice address
6455 N Wickham Rd Ste 103
Melbourne, FL 32940-2020
Phone
(321) 420-4142
NPI assigned
Nov 14, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2018

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

Authorized official

Name
Dr. Katie L McCann Lee, DDS
Title
Owner
Phone
(321) 420-4142

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

6455 N Wickham Rd Ste 103
Melbourne, FL 32940-2020

Mailing address

17000 Red Hill Ave
Irvine, CA 92614-5626

Other names 1

  • Dentists of Melbourne Doing business as

National Provider Directory

National Provider Directory

Locations

6455 N Wickham Rd
Unit 103
Melbourne, FL 32940
Phone (321) 420-4142

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1510617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1545004800000",
    "number": "1871006742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17000 RED HILL AVE",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926145626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6455 N WICKHAM RD STE 103",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329402020",
            "telephone_number": "321-420-4142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTISTS OF MELBOURNE, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-14",
        "last_updated": "2018-12-17",
        "status": "A",
        "authorized_official_last_name": "MCCANN LEE",
        "authorized_official_first_name": "KATIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "321-420-4142",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dentists of Melbourne",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Melbourne, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 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.