PROFESSIONAL DENTAL ALLIANCE OF LAKE WASHINGTON, PLLC (NPI# 1558840371) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558840371 |
| Entity Type | Organization |
| Organization Name | PROFESSIONAL DENTAL ALLIANCE OF LAKE WASHINGTON, PLLC |
| Other Organization Name | NEW IMAGE DENTISTRY LAKE WASHINGTON |
| Practice Address |
3226 Lake Washington Rd Ste 16 Melbourne FL 32934-7620 |
| Mailing Address |
11 S Mill St Ste 200 New Castle PA 16101-3680 |
| Practice Telephone | 3212551991 |
| Mailing Telephone | 7246982500 |
| 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 Lake Washington | Doing Business As Name - Organization |
| Street Address |
3226 LAKE WASHINGTON RD STE 16 |
| City | MELBOURNE |
| State | FL |
| Zip Code | 32934-7620 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790301752 | Nour Elkhatib | Dentist | 3226 Lake Washington Rd Ste 16, Melbourne, FL 32934-7620 | 2020-06-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013530419 | Ryan Thomas Kammerdener | Pharmacist | 3003 Bay Wind Ct, Melbourne, FL 32934 | 2020-05-20 |
| 1558833731 | Deborah J Gaffney | Specialist/Technologist | 3060 Kershaw Court, Melbourne, FL 32934 | 2018-12-27 |
| 1548703200 | Damaris Escarment | Counselor | 3550 W. Eau Gallie Blvd, Melbourne, FL 32934 | 2016-11-29 |
| 1447686324 | Sarai Escarment | Counselor | 3550 W Eau Gallie Blvd, Melbourne, FL 32934 | 2013-09-23 |
| 1871874974 | Felipe E. Dominguez, Md, Pa | Clinical Medical Laboratory | 3030 Venture Lane, Ste 108, Melbourne, FL 32934 | 2011-09-01 |
| 1376821637 | Christine Natasha Williams Kelly | Counselor | 4450 West Eau Gallie Blvd, Suite 200, Melbourne, FL 32934 | 2011-08-03 |
| 1912203316 | Sheryl Yatsko | Physical Therapy Assistant | 3303 Sarno Rd, Melbourne, FL 32934 | 2011-02-01 |
| 1255564191 | Joy Cheryl Mullen | Occupational Therapy Assistant | 1890 Whispering Oaks Cir, West Melbourne, FL 32934 | 2009-08-26 |
| 1619031531 | The Devereux Foundation | Case Management | 1591 Robert J Conlan Boulevard, Palm Bay, FL 32934 | 2006-12-22 |
| 1457456600 | Jo A Kologlu | Physical Therapist | 5025 Smithfield Rd, Melbourne, FL 32934 | 2006-09-13 |
| Find all providers in zip 32934 | ||||
| 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 |
|---|---|---|---|---|
| 1891268413 | Dynamic Dental Health Associates of Florida Pa | Dentist | 2419 S Babcock St, Melbourne, FL 32901-5310 | 2019-01-07 |
| 1275045817 | Comfortable Care Dental Health Professionals. P.a. | Dentist | 6340 N Wickham Rd Ste 101, Melbourne, FL 32940 | 2017-11-03 |
| 1295264232 | Christian Vidalon | Dentist | 7827 N Wickham Rd Ste C, Melbourne, FL 32940-8289 | 2017-06-04 |
| 1851750426 | Derek Chenet | Dentist | 7331 Office Park Pl Ste 100, Melbourne, FL 32940-8238 | 2016-02-11 |
| 1659770725 | New Image Dentistry of West Melbourne | Dentist | 2025 W New Haven Ave, Melbourne, FL 32904-3801 | 2014-08-14 |
| 1922413046 | Alfredo Enrique Torras Ceballos | Dentist | 6555 N Wickham Rd Ste 106, Melbourne, FL 32940 | 2014-06-26 |
| 1275880742 | Natalia Valderrama Dougherty | Dentist | 903 Jordan Blass Dr Ste 102, Melbourne, FL 32940-1325 | 2012-08-14 |
| 1306118674 | Comfortable Care Dental Health Professionals, Pa | Dentist | 2900 Lake Washington Rd Ste 2, Melbourne, FL 32935-3400 | 2012-02-02 |
| 1952696007 | Daniel Warren Eley | Dentist | 2301 W Eau Gallie Blvd, Suite 102, Melbourne, FL 32935-3120 | 2011-06-16 |
| 1124320585 | Nicholas Brad Rowley | Dentist | 205 W New Haven Ave, Melbourne, FL 32901-4300 | 2010-11-17 |
| Find all providers in MELBOURNE | ||||
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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.