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Organization Active NPI

Pompano Beach Periodontics PLLC

  • Periodontics
  • Pompano Beach, FL
National Provider Identifier
1972930774
Registry record updated Oct 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
DN18938 Issued in FL
Legal business name
POMPANO BEACH PERIODONTICS PLLC
Practice address
2231 NE 25TH Ave
Suite 4
Pompano Beach, FL 33062-1148
Phone
(954) 782-7911
Fax
(954) 782-7925
NPI assigned
Oct 11, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2013

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

Authorized official

Name
Dr. Jason A Witonsky, DMD
Title
Managingmember
Phone
(954) 782-7911

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0300X DN18938 FL Primary

Addresses

Primary practice location

2231 NE 25TH Ave
Suite 4
Pompano Beach, FL 33062-1148

Mailing address

2231 NE 25TH Ave
Suite 4
Pompano Beach, FL 33062-1148
Phone (954) 782-7911

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1381449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381449600000",
    "number": "1972930774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2231 NE 25TH AVE",
            "address_2": "SUITE 4",
            "city": "POMPANO BEACH",
            "state": "FL",
            "postal_code": "330621148",
            "telephone_number": "954-782-7911",
            "fax_number": "954-782-7925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2231 NE 25TH AVE",
            "address_2": "SUITE 4",
            "city": "POMPANO BEACH",
            "state": "FL",
            "postal_code": "330621148",
            "telephone_number": "954-782-7911",
            "fax_number": "954-782-7925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POMPANO BEACH PERIODONTICS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-11",
        "last_updated": "2013-10-11",
        "status": "A",
        "authorized_official_last_name": "WITONSKY",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MANAGINGMEMBER",
        "authorized_official_telephone_number": "954-782-7911",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "FL",
            "license": "DN18938",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pompano Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2013; 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.