Main Street Children'S Dentistry and Orthodontics of South Broward, PA

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

MAIN STREET CHILDREN'S DENTISTRY AND ORTHODONTICS OF SOUTH BROWARD, PA

Practice address

9900 Stirling Rd., Suite 100
Cooper City, FL 33024

Phone

(954) 432-8707

NPI assigned

Aug 31, 2006

Organization subpart

No

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

Authorized official

Name

Stephanie Gomez

Title

Provider Relations

Phone

(305) 274-2499

Specialties & licenses 1

Addresses

Other names 1

• Main Street Orthodontics of South Broward Doing business as

Tax ID family

Main Street Children'S Dentistry and Orthodontics of South Broward PA2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Main Street Children'S Dentistry and Orthodontics of South Broward, PA

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Hollywood, FL
  • NPI 1407951833
  NPD tax ID

Locations

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1408579200000",
    "number": "1891807160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13195 SW 134 ST",
            "address_2": "2ND FLOOR",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "33186",
            "telephone_number": "305-274-2499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9900 STIRLING RD., SUITE 100",
            "city": "COOPER CITY",
            "state": "FL",
            "postal_code": "33024",
            "telephone_number": "954-432-8707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET CHILDREN'S DENTISTRY AND ORTHODONTICS OF SOUTH BROWARD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2014-08-21",
        "status": "A",
        "authorized_official_last_name": "GOMEZ",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "PROVIDER RELATIONS",
        "authorized_official_telephone_number": "305-274-2499"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Main Street Orthodontics of South Broward",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Teresa Lorenzo, ARNP
• Lori Sawyer-Lyons PSYD,PA
• Lauren Y Love, D.C.
• Manitha Lubin
• Rhonda D Madison
• William G Malcolm, DPM
• Jennifer E Malpass, RDN
• Kristen Marjama, FNP-C
• Irene J Marshall, LMFT
• Alfredo Martin, D.M.D.

• Pediatric Dentistry in Cooper City, FL
• Providers in Cooper City, FL by specialty
• Pediatric Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2014; 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.