Main Street Children's Dentistry and Orthodontics of Boca Raton, P.a.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

MAIN STREET CHILDREN'S DENTISTRY AND ORTHODONTICS OF BOCA RATON, P.A.

Doing business as

Main Street Children's Dentistry of Boca Raton

Practice address

595 S Federal Hwy Ste 130
Boca Raton, FL 33432-6096

Phone

(561) 826-7955

NPI assigned

Oct 11, 2011

Last updated

Jul 10, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Melvyn Gober, DDS

Title

Ceo

Phone

(305) 274-2499

Specialties & licenses 2

Addresses

Other names 1

• Main Street Children's Dentistry of Boca Raton Doing business as

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

{
    "created_epoch": "1318291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341878400000",
    "number": "1932483864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13195 SW 134TH ST FL 2",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331864461",
            "telephone_number": "305-274-2499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "595 S FEDERAL HWY STE 130",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334326096",
            "telephone_number": "561-826-7955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET CHILDREN'S DENTISTRY AND ORTHODONTICS OF BOCA RATON, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-11",
        "last_updated": "2012-07-10",
        "status": "A",
        "authorized_official_last_name": "GOBER",
        "authorized_official_first_name": "MELVYN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "305-274-2499",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Main Street Children's Dentistry of Boca Raton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Olena Mahneva, DO
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• Madeline Main
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• David Makover, MD
• Jennifer Sy Malana-Katigbak
• Valerie Malcolm, R.N.

• Pediatric Dentistry in Boca Raton, FL
• Providers in Boca Raton, FL by specialty
• Pediatric Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2012; 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.