Main Street Children'S Dentistry and Orthodontics of Ft. Myers, P.a.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

MAIN STREET CHILDREN'S DENTISTRY AND ORTHODONTICS OF FT. MYERS, P.A.

Practice address

13195 Metro Pkwy
Fort Myers, FL 33966-4810

Phone

(239) 768-2485

NPI assigned

May 13, 2011

Organization subpart

No

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

Authorized official

Name

Stephanie Gomez

Title

Provider Relations Specialist

Phone

(305) 274-2499

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1305244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406851200000",
    "number": "1962794602",
    "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",
            "fax_number": "305-274-9312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13195 METRO PKWY",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339664810",
            "telephone_number": "239-768-2485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET CHILDREN'S DENTISTRY AND ORTHODONTICS OF FT. MYERS, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-13",
        "last_updated": "2014-08-01",
        "status": "A",
        "authorized_official_last_name": "GOMEZ",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "PROVIDER RELATIONS SPECIALIST",
        "authorized_official_telephone_number": "305-274-2499"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Dentistry in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Pediatric Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2014; 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.