Ft Myers Dental Service PA

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

Legal business name

FT MYERS DENTAL SERVICE PA

Doing business as

Main Street Orthodontics of Ft Myers

Practice address

6150 Diamond Centre CT
BLDG 300, Suite 2
Fort Myers, FL 33912-4365

Phone

(239) 768-2485

Fax

(239) 433-5557

NPI assigned

Aug 15, 2007

Organization subpart

No

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

Authorized official

Name

Melody Parrish

Title

Director of Operations

Phone

(305) 274-2499

Specialties & licenses 1

Addresses

Other names 1

• Main Street Orthodontics of Ft Myers Doing business as

Tax ID family

Ft Myers Dental Service PA3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Ft. Myers Dental Services, PA

  • Pediatric Dentistry
  • Fort Myers, FL
  • NPI 1437479169
  NPD tax ID
• Ft.Myers Dental Services, P.a.

  • General Practice Dentistry
  • Ft Myers, FL
  • NPI 1528171071
  NPD tax ID

Locations

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

{
    "created_epoch": "1187136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187136000000",
    "number": "1942492806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6150 DIAMOND CENTER COURT",
            "address_2": "BLDG 300, SUITE 2",
            "city": "FT. MYERS",
            "state": "FL",
            "postal_code": "33912",
            "telephone_number": "239-768-2485",
            "fax_number": "239-433-5557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6150 DIAMOND CENTRE CT",
            "address_2": "BLDG 300, SUITE 2",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339124365",
            "telephone_number": "239-768-2485",
            "fax_number": "239-433-5557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FT MYERS DENTAL SERVICE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-15",
        "last_updated": "2007-08-15",
        "status": "A",
        "authorized_official_last_name": "PARRISH",
        "authorized_official_first_name": "MELODY",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "305-274-2499"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Main Street Orthodontics of Ft Myers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Malorie Nicole Fry, MS, RD
• Olivia Fry, RMHCI
• FS Tenant Pool IV Trust
• FSQ the Palms at Fort Myers LLC
• Ft Myers Alf BSLC LLC
• Ft Myers Digestive Health and Pain ASC LLC
• Ft Myers FL Ophthalmology ASC LLC
• Ft. Myers Chiropractic Center, Inc.
• Ft. Myers Dental Services, PA
• Ft. Myers MRI, LLC

• Orthodontics and Dentofacial Orthopedics Dentistry in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2007; 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.