Supradent Inc

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

SUPRADENT INC

Practice address

18515 US Hwy 441
Mount Dora, FL 32757-6703

Phone

(352) 383-5377

Fax

(352) 383-2513

NPI assigned

Nov 29, 2006

Organization subpart

No

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

Authorized official

Name

Dr. James P Costello, DDS

Title

President

Phone

(352) 408-1400

Specialties & licenses 1

Addresses

Other names 1

• Tri Dental Doing business as

Locations

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1932276565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18515 US HWY 441",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327576703",
            "telephone_number": "352-383-5377",
            "fax_number": "352-383-2513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18515 US HWY 441",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327576703",
            "telephone_number": "352-383-5377",
            "fax_number": "352-383-2513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPRADENT INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "COSTELLO",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "352-408-1400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "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": "Tri Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rebekah Lee Sturgill
• Christina Maria Suarez, M.A.
• Wynbeth Sumayang, ARNP, FNP-C
• Sunshine Behavioral and Mental Health Center
• Sunshine Recovery Network, Inc
• Surgery Center of Mount Dora, LLC
• Shareen Sutherland, NP
• Alethea Swearine, MA, BCBA
• Grace Tavarez
• Kevin Thomas Taylor, MD

• General Practice Dentistry in Mount Dora, FL
• Providers in Mount Dora, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.