Active NPI
Dustin Dedomenico, DMD MS
- Pediatric Dentistry
- Tampa, FL
National Provider Identifier
1902224975
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- DN20727
- Practice address
- 11012 N Dale Mabry Hwy Ste 302
Tampa, FL 33618-3821 - Phone
- (813) 961-1414
- NPI assigned
- Apr 7, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | KY 9443 | KY | |
| Pediatric Dentistry | 1223P0221X | DN20727 | FL | Primary |
Addresses
Primary practice location
11012 N Dale Mabry Hwy Ste 302
Tampa, FL 33618-3821
Mailing address
11012 N Dale Mabry Hwy Ste 302
Tampa, FL 33618-3821
Phone (813) 961-1414
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| KY 9443 | KY | MD | Dentist |
| DN20727 | FL | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1396828800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1474675200000",
"number": "1902224975",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11012 N DALE MABRY HWY STE 302",
"city": "TAMPA",
"state": "FL",
"postal_code": "336183821",
"telephone_number": "813-961-1414"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11012 N DALE MABRY HWY STE 302",
"city": "TAMPA",
"state": "FL",
"postal_code": "336183821",
"telephone_number": "813-961-1414"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEDOMENICO",
"first_name": "DUSTIN",
"credential": "DMD MS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-04-07",
"last_updated": "2016-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "KY",
"license": "KY 9443",
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "FL",
"license": "DN20727",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tampa, FL
- Christina Decoveny, DPT
- Dedicated Senior Medical Center East Tampa, LLC.
- Dedicated Senior Medical Center of Florida, LLC
- Dedicated Senior Medical Centers of Florida, LLC
- Dedicated Senior Medical Centers of Florida, LLC
- Ralph J Dedomenico, DMD
- Shannon Elizabeth Dedomenico, MA, CCC-SLP
- Alex R Deem, MD
- Deen G King MD PA
- Deanna Deenihan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.