PROFESSIONAL DENTAL ALLIANCE OF BAYSIDE LAKES, PLLC (NPI# 1346729167) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346729167 |
| Entity Type | Organization |
| Organization Name | PROFESSIONAL DENTAL ALLIANCE OF BAYSIDE LAKES, PLLC |
| Other Organization Name | NEW IMAGE DENTISTRY BAYSIDE LAKES |
| Practice Address |
3590 Bayside Lakes Blvd Se Ste 1 Palm Bay FL 32909-6866 |
| Mailing Address |
11 S Mill St Ste 200 New Castle PA 16101-3680 |
| Practice Telephone | 3219840044 |
| Practice Fax Number | 3219840707 |
| Mailing Telephone | 7246982119 |
| Enumeration Date | 2018-08-13 |
| Last Update Date | 2018-08-13 |
| Authorized Official Name | ANNETTE MARLOW (CREDENTIALING SUPERVISOR) |
| Authorized Official Telephone | 7246982119 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
Dental Providers |
| Other Name | Type Code |
|---|---|
| New Image Dentistry Bayside Lakes | Doing Business As Name - Organization |
| Street Address |
3590 BAYSIDE LAKES BLVD SE STE 1 |
| City | PALM BAY |
| State | FL |
| Zip Code | 32909-6866 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942650155 | Karan Doomra | Dentist | 3590 Bayside Lakes Blvd Se Ste 1, Palm Bay, FL 32909-6866 | 2016-06-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205447349 | Sarah Nicosia | Registered Nurse | 2752 Palisades Dr, Palm Bay, FL 32909 | 2020-08-12 |
| 1447881297 | Shangri-la of Palm Bay Alf, LLC | Assisted Living Facility | 3604 Jupiter Blvd. Se, Palm Bay, FL 32909 | 2020-01-30 |
| 1972094357 | Mindful Counseling and Wellness LLC | Social Worker | 221 Devlin Ct Se, Palm Bay, FL 32909 | 2018-05-22 |
| 1306348859 | Mallory Kathleen Herndon | Behavior Technician | 458 Barcelona Rd, Palm Bay, FL 32909 | 2018-03-01 |
| 1548786627 | Chotsani Merrill | Home Health Aide | 781 Davenport St Se, Palm Bay, FL 32909 | 2017-08-21 |
| 1639629538 | Maggie Cameron | Clinic/Center | 2511 Quentin Ave Ne, Palm Bay, FL 32909 | 2016-10-04 |
| 1194195016 | Dawn Goodwin | Pharmacist | 3450 Bayside Lakes Shopping Center, Palm Bay, FL 32909 | 2015-10-05 |
| 1124407796 | Jorge Ortiz | Physical Therapist | 470 Malabar Rd Se, Ste 102, Palm Bay, FL 32909 | 2015-05-28 |
| 1932506227 | Annalisa Tietjen I | Dental Hygienist | 714 Ave C, Fort Pierce, FL 32909 | 2014-12-02 |
| 1194147611 | Carl Glenmore Morrison Sr. | General Practice | 2125 Windbrook Drive, Palm Bay, FL 32909 | 2014-01-17 |
| Find all providers in zip 32909 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518517077 | Professional Dental Alliance of Palm Bay Palm Bay Rd, Pllc | Dentist | 1890 Palm Bay Rd Ne Ste 2, Palm Bay, FL 32905-3071 | 2019-09-17 |
| 1528547353 | Professional Dental Alliance of Minton, Pllc | Dentist | 5132 Minton Rd Nw Ste A, Palm Bay, FL 32907-1110 | 2018-08-13 |
| 1942650155 | Karan Doomra | Dentist | 3590 Bayside Lakes Blvd Se Ste 1, Palm Bay, FL 32909-6866 | 2016-06-18 |
| 1285047506 | New Image Dentisty of Palm Bay | Dentist | 3590 Bayside Lakes Blvd Se, Palm Bay, FL 32909-6866 | 2014-06-04 |
| 1558602169 | Subhash G Rege | Dentist | 1764 Palm Bay Rd Ne, Palm Bay, FL 32905-2904 | 2013-03-06 |
| 1083974901 | Liliana Marshall Dmd Pllc | Dentist | 2186 Harris Ave Ne Ste 3, Palm Bay, FL 32905-4044 | 2012-05-24 |
| 1457628505 | Paula Fiuza Bielak | Dentist | 5132 Minton Rd Nw Ste I, Palm Bay, FL 32907-1110 | 2011-11-17 |
| 1851611669 | Eva Maria Napoles Rodriguez | Dentist | 1421 Malabar Rd Ne Ste 240, Palm Bay, FL 32907-2559 | 2010-06-03 |
| 1679703185 | Curtis B. Hill, Jr., Dmd, Pa | Dentist | 1400 Palm Bay Rd Ne, Ste A, Palm Bay, FL 32905-3851 | 2009-07-17 |
| 1962615716 | Theresa A Yasonis | Dentist | 730 Emerson Dr Ne, Palm Bay, FL 32907-1430 | 2007-05-08 |
| Find all providers in PALM BAY | ||||
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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.