ADVANCED ENDODONTICS OF WINTER PARK, PA — NPI 1417587130 (Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) in WINTER PARK, FL)

CMS-1500 Box 24J / 33a • NPI

1417587130

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

1223E0200X

Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)

Box 32 Service Location & ZIP+4

400 W MORSE BLVD STE 102, WINTER PARK, FL, 32789-4259

✓ 9-Digit EDI 837 ZIP+4 (32789-4259)

Practice Phone & Referral Fax

(407) 574-4271

Fax: (407) 674-2539

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1417587130 (ADVANCED ENDODONTICS OF WINTER PARK, PA) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1417587130` (NPI-2 Organization / Facility)
Provider / Legal Name	ADVANCED ENDODONTICS OF WINTER PARK, PA
Plain-English Specialty	Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) NUCC Code: `1223E0200X` (Dentist, Endodontics)
Certifying / Licensing Body	American Dental Association (ADA) / State Board of Dental Examiners
Practice Location Address	400 W MORSE BLVD STE 102, WINTER PARK, FL, 32789-4259
Practice Telephone / Fax	Tel: (407) 574-4271 \| Fax: (407) 674-2539
Administrative Mailing Address	743 STIRLING CENTER PL STE 1701, LAKE MARY, FL, 32746-5712
Enumeration & Last Sync	Enumerated: 2020-01-22 \| CMS Record Updated: 2020-01-22
Authorized Official	AMBER PERRY (CFO)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

400 W MORSE BLVD STE 102, WINTER PARK, FL, 32789-4259

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Plain-English Taxonomy & CMS Crosswalk (1223E0200X)

What Does Taxonomy Code 1223E0200X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 1223E0200X translates to:
"Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: American Dental Association (ADA) / State Board of Dental Examiners
Clinical Scope: Routine 6-month dental checkups, toothache, dental abscess, bleeding gums (periodontitis), or wisdom tooth extraction.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (ADVANCED ENDODONTICS OF WINTER PARK, PA)

Typical CPT / Diagnostic Procedures:

Comprehensive Oral Evaluation, Digital Dental Radiographs & Prophylaxis
Restorative Composite Fillings, Crowns, Endodontic Root Canal & Extractions

Common Therapeutic Classes:

Amoxicillin, Metronidazole & Clindamycin (Odontogenic Infections)
Chlorhexidine Gluconate 0.12% Oral Rinse & High-Fluoride Varnish

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`1223E0200X` — Dentist, Endodontics Plain English: Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

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ADVANCED ENDODONTICS OF WINTER PARK, PA (NPI #1417587130)