NPIMap

Organization Active NPI

Florida Dental Professionals, P.a.

  • General Practice Dentistry
  • Naples, FL
National Provider Identifier
1891293387
Registry record updated Jan 30, 2018
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
6360 Pine Ridge Rd Ste 202
Naples, FL 34119-3907
Phone
(239) 354-5353
NPI assigned
Jan 30, 2018
Organization subpart
Yes
Parent organization
FLORIDA DENTAL PROFESSIONALS, P.A.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 30, 2018

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

Authorized official

Name
Cassandra Petersen
Title
Credentialing Team Lead
Phone
(217) 540-8972

Specialties & licenses 1

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

Addresses

Primary practice location

6360 Pine Ridge Rd Ste 202
Naples, FL 34119-3907

Mailing address

6360 Pine Ridge Rd Ste 202
Naples, FL 34119-3907
Phone (239) 354-5353

Other names 1

  • Complete Dental Care of Naples 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.

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.

Practitioners & affiliated clinicians

Practitioners 3

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": "1517270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1517270400000",
    "number": "1891293387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6360 PINE RIDGE RD STE 202",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341193907",
            "telephone_number": "239-354-5353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6360 PINE RIDGE RD STE 202",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341193907",
            "telephone_number": "239-354-5353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA DENTAL PROFESSIONALS, P.A.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FLORIDA DENTAL PROFESSIONALS, P.A.",
        "enumeration_date": "2018-01-30",
        "last_updated": "2018-01-30",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "CASSANDRA",
        "authorized_official_title_or_position": "CREDENTIALING TEAM LEAD",
        "authorized_official_telephone_number": "217-540-8972"
    },
    "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": "Complete Dental Care of Naples",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Naples, FL

Sources for this page

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