Active NPI
Javier Broche
- Dentist
- Kissimmee, FL
National Provider Identifier
1902697311
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN30610
- Practice address
- 3192 S John Young Pkwy
Kissimmee, FL 34746-8814 - Phone
- (407) 870-5151
- NPI assigned
- May 15, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN30610 | FL | Primary |
Addresses
Primary practice location
3192 S John Young Pkwy
Kissimmee, FL 34746-8814
Mailing address
1958 Rider Rain LN
Apopka, FL 32703-8370
Phone (786) 339-4039
Other practice location 1
13512 S John Young Pkwy
Orlando, FL 32837-7658
Phone (407) 606-6148
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250917003382 | FL | Order and Referring Only - Dentist | 9537663174 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN30610 | FL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ata Dental Kissimmee LLC | Past | Accepting new patients | |
| Mount Dora Modern Dentistry, PA | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Kissimmee, FL
- NPI 1366001471
-
dba Mount Dora Modern Dentistry
- General Practice Dentistry
- Eustis, FL
- NPI 1659815306
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1747267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1764633600000",
"number": "1902697311",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1958 RIDER RAIN LN",
"city": "APOPKA",
"state": "FL",
"postal_code": "327038370",
"telephone_number": "786-339-4039"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3192 S JOHN YOUNG PKWY",
"city": "KISSIMMEE",
"state": "FL",
"postal_code": "347468814",
"telephone_number": "407-870-5151"
}
],
"practiceLocations": [
{
"address_1": "13512 S John Young Pkwy",
"address_purpose": "LOCATION",
"city": "Orlando",
"state": "FL",
"postal_code": "328377658",
"country_code": "US",
"telephone_number": "407-606-6148",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BROCHE",
"first_name": "JAVIER",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-05-15",
"last_updated": "2025-12-02",
"certification_date": "2025-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "DN30610",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kissimmee, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.