Midtown Dental Center LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN16582 Issued in FL

Legal business name

MIDTOWN DENTAL CENTER LLC

Practice address

3011 Central Ave
St Petersburg, FL 33713-8632

Phone

(727) 322-1828

NPI assigned

Feb 13, 2012

Last updated

Feb 13, 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

Jacqueline Nelson-Mangatal, DDSNPI 1154446649

Title

Dentist

Phone

(786) 316-5044

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jacqueline Nelson-Mangatal, D.D.S.

  • Dentist
  • St Petersburg, FL
  • NPI 1154446649
  NPD (past) Authorized official

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

{
    "created_epoch": "1329091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329091200000",
    "number": "1992078521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12197",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337332197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3011 CENTRAL AVE",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337138632",
            "telephone_number": "727-322-1828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDTOWN DENTAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-13",
        "last_updated": "2012-02-13",
        "status": "A",
        "authorized_official_last_name": "NELSON-MANGATAL",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "786-316-5044",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN16582",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "075681400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michelle Spuza Milord MD PA
• John Thomas Michoian, RN
• Stase Elena Michota
• Dominique Jalisia Mickler, LCSW
• Darly Micourt, ARNP
• Megan Midura
• Carol F Miele, LMHC
• Wendy Jean Migliore Sanchez, ARNP
• Miguel a. Espinal, MD. PA
• Roland Joseph Mihalik, RPH

• General Practice Dentistry in St Petersburg, FL
• Providers in St Petersburg, 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 Feb 13, 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.