LAKE MARY MODERN DENTISTRY, PA (NPI# 1053849646) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053849646 |
| Entity Type | Organization |
| Organization Name | LAKE MARY MODERN DENTISTRY, PA |
| Practice Address |
3779 Lake Emma Road Lake Mary FL 32746 |
| Mailing Address |
17000 Red Hill Ave Irvine CA 92614-5626 |
| Practice Telephone | 4075471359 |
| Enumeration Date | 2017-05-26 |
| Last Update Date | 2017-05-26 |
| Authorized Official Name | KATIE L. MCCANN (DDS/OWNER) |
| Authorized Official Telephone | 4075471359 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | Dental Providers |
| Street Address |
3779 LAKE EMMA ROAD |
| City | LAKE MARY |
| State | FL |
| Zip Code | 32746 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588286397 | James Maggert | Physical Therapist | Sst Rehab, 635 Century Pt - Suite 111, Lake Mary, FL 32746 | 2020-05-14 |
| 1225663743 | Jamie Pecot | Behavior Technician | 300 International Parkway, 200, Lake Mary, FL 32746 | 2020-03-04 |
| 1619509585 | Dental Associates of Heathrow, LLC | Dentist | Dental Associates of Heathrow, LLC, 120 International Parkway Suite 26, Heathrow, FL 32746 | 2020-02-10 |
| 1376185876 | Rinehart Road Surgery Center, LLC | Clinic/Center | 392 Rinehart Road, Suite 1100, Lake Mary, FL 32746 | 2019-10-16 |
| 1871140988 | Central Florida Wellness LLC | General Practice | 1061 S Sun Drove, Suite 1041, Lake. Mary, FL 32746 | 2019-08-22 |
| 1326609942 | Antoine Slade I | Behavior Technician | 4876 Rhinehart Road, Lake Mary, FL 32746 | 2019-06-25 |
| 1245891209 | Ohri, LLC | Clinic/Center | 392 Rinehart Rd., Suite 1300, Lake Mary, FL 32746 | 2019-06-21 |
| 1336610856 | Olivia Laurel Stolz | Physician Assistant | 3300 West Lake Mary Blvd, 220, Lake Mary, FL 32746 | 2018-12-10 |
| 1881171072 | Elite-star Medical Transport LLC. | Non-emergency Medical Transport (VAN) | 2910 W Lake Mary Blvd Ste 101, Lake Mary, FL 32746 | 2018-07-20 |
| 1508351537 | Ariagny Elena Fereira | Speech-Language Pathologist | 145 Middle Street Suite 1101, Lake Mary, FL 32746 | 2018-06-22 |
| Find all providers in zip 32746 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891337366 | Omeir Tariq Ansari | Dentist | 3779 Lake Emma Rd, Lake Mary, FL 32746-6156 | 2019-10-16 |
| 1942782594 | Marco Antonio Mongalo | Dentist | 2684 Cahill Way, Lake Mary, FL 32746-2322 | 2018-08-30 |
| 1285122788 | Michelle Dellapenta Bargfrede | Dentist | 4267 W Lake Mary Blvd., Lake Mary, FL 32746 | 2018-04-30 |
| 1205351657 | Healthy Smiles of Orlando LLC | Dentist | 946 International Pkwy Ste 1550, Lake Mary, FL 32746-5219 | 2017-08-07 |
| 1831579457 | Aaron M. Goodwin | Dentist | 731 Stirling Center Pl Unit 1951, Lake Mary, FL 32746-5210 | 2015-06-09 |
| 1144437831 | Timothy Tiralosi | Dentist | 731 Stirling Center Pl, Suite 1951, Lake Mary, FL 32746-5209 | 2007-05-16 |
| 1023106333 | Effie C Yao | Dentist | 4106 W Lake Mary Blvd Ste 230, Lake Mary, FL 32746-2403 | 2006-10-11 |
| 1558467530 | Patricia Nino De Guzman Roach | Dentist | 3300 W Lake Mary Blvd Ste 250, Lake Mary, FL 32746-3571 | 2006-09-16 |
| 1235242330 | Carla Dawn Webb | Dentist | 3801 W Lake Mary Blvd, Lake Mary, FL 32746-6159 | 2006-08-16 |
| 1922017367 | Ceasar M Garcia | Dentist | 4267 W Lake Mary Blvd, Lake Mary, FL 32746 | 2006-08-05 |
| Find all providers in LAKE MARY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.