Attachment_B-Top_Dentist_List_REVISED.xlsx

XLSX spreadsheet 20 KB Posted

Attached to
Group Dental Plan State and local contract opportunity
Solicitation number
048-PLA-0515
Issued by
Polk County, Florida

About this file

This is a Top Dentist List attachment for a Request for Proposal (RFP) issued by the School Board of Polk County, Florida for a voluntary, fully insured Group Dental Plan. The document serves as a provider network submission form requiring bidding dental insurance firms to identify which providers from the specified list are contracted within their PPO network. The attachment lists 150 dental providers across multiple specialties—including general dentists, pediatric dentists, periodontists, endodontists, oral surgeons, and prosthodontists—located throughout Polk County and surrounding areas in Florida. Each provider entry includes their Florida license number, National Provider Identifier (NPI), specialty designation, name, address, city, state, ZIP code, number of claimants, and claims history. Bidders must indicate with an "X" in the designated yellow column which providers are in-network for their PPO plan options and note any providers excluded from specific plan options.

Submission of the completed Top Dentist List is mandatory as part of the proposal response, with the form required in both hard copy and Excel format as specified in the RFP. The document does not contain specific pricing information, set-asides, contract term details, award dates, or renewal options; these details would be found in the main RFP document. The list appears designed to assess bidder network depth and coverage of the local provider community, allowing the School Board to evaluate which carrier offers the most comprehensive access to established dental providers with existing patient relationships in the Polk County area.

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Other files for this state and local contract opportunity

Other files attached to Group Dental Plan, newest first.
File Type Posted
048-PLA-0515_Renewal_for_2021_and_2022.pdf PDF
RFP_048-PLA-0515_Board_Approval_Renewal_2019-2020.pdf PDF
048-PLA-0515_Renewal_RFP-Group_Dental_Plan_2018-2020_.pdf PDF
Attachment_B-Top_Dentist_List.xlsx XLSX spreadsheet
Attachment_D-Certificate_of_Coverage.pdf PDF
NRBA_048-PLA-0515.pdf PDF
Attachment_A-RFP_Proposal_Worksheet_REVISED.docx DOCX document
Attachment_A-_RFP_Proposal_Worksheet.docx DOCX document
Attachment_E-Census.xlsx XLSX spreadsheet
Attachment_F-Dental_Claims_Experience_.zip ZIP file
048-PLA-0515_RFP-Group_Dental_Plan_.pdf PDF
Addendum_01.pdf PDF
Attachment_C-_Top_Dental_Procedures.xlsx XLSX spreadsheet
Attachment_G-Updated_Experience_Report.xlsx XLSX spreadsheet
Addendum_02.pdf PDF
Award_048-PLA-0515.pdf PDF
Show all 16

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ProvUtil

School Board of Polk County
Group Dental Plan, RFP #048-PLA-0515
ATTACHMENT B - TOP DENTIST LIST (REVISED)
INSTRUCTIONS: In the yellow highlighted column please place an "X" next to each provider contracted in your PPO network. Please note if a dentist is excluded from any of the three PPO plan options. This form must be completed in full and submitted with your proposal in hard copy and in Excel format as specified in the Request for Proposal.
LICENSENPISPECIALTYNAMEADDRESSCITYSTATEZIPCLAIMANTSCLAIMSIn-network
000007209FL1477637056GENERAL DENTISTBILLY B BROWN JR695 S BROADWAY AVEBARTOWFL338303802237
000012385FL1487860151GENERAL DENTISTTHOMAS F PLUNKETT200 LAKE HARRIS DRLAKELANDFL338133312202
000005979FL1780605956PEDIATRIC DENTISTHARRY BOPP1111 N PARKWAY FRONTAGE RDLAKELANDFL338033272418
000009526FL1174698492GENERAL DENTISTPHILLIP E ABBOTT780 E MAIN STBARTOWFL338302731398
000013636FL1952525008GENERAL DENTISTROBERT M PRISBE3835 S FLORIDA AVELAKELANDFL338132341527
000011387FL1528246501GENERAL DENTISTJAMES A TRUITT144 AVENUE B NWWINTER HAVENFL33881221988
000010569FL1013093210GENERAL DENTISTLINDA J MAY1495 E MAIN STBARTOWFL338302121397
000015466FL1457453664GENERAL DENTISTJAMIE W ODOM361 E CENTRAL AVEWINTER HAVENFL338802011002
000010739FL1306094313GENERAL DENTISTSIUHUNG H FAN211 E LIME STLAKELANDFL33801201806
000017361FL1881735314GENERAL DENTISTPATRICK MICHAEL FERRY715 S BROADWAY AVEBARTOWFL33830185957
000007033FL1629107602GENERAL DENTISTCRAIG W VALENTINE310 E HIGHLAND DRLAKELANDFL33813166620
000008379FL1780080291GENERAL DENTISTGLENN R SHEUMAKER JR6731 US HIGHWAY 98 NLAKELANDFL33809165865
000017195FL1619990173PEDIATRIC DENTISTEDWARD JORDAN TARVER1111 N PARKWAY FRONTAGE RDLAKELANDFL338031621205
000008327FL1053468637GENERAL DENTISTBRADLEY W BARTEL150 AVENUE A SEWINTER HAVENFL33880161774
000011515FL1083637334PEDIATRIC DENTISTKENNETH BENJAMINE ROGERS1550 1ST ST SWINTER HAVENFL33880158942
000011131FL1093750630GENERAL DENTISTBELKIS Z JONES5406 STRICKLAND AVELAKELANDFL33812157827
000013488FL1912219759GENERAL DENTISTSTEVEN CIARAVINO294 PATTERSON RDHAINES CITYFL33844148732
000014392FL1942333927GENERAL DENTISTSTEPHEN J WALDING III3615 S FLORIDA AVE STE 850LAKELANDFL338031411187
000007428FL1164621918GENERAL DENTISTGARY L JOYNER2025 FLAMINGO DRBARTOWFL33830140614
000018565FL1083725725GENERAL DENTISTDIANA K CRAFT310 E HIGHLAND DRLAKELANDFL33813138727
000018925FL1336161900PEDIATRIC DENTISTTIFFANY YI-TING CHEN1550 1ST ST SWINTER HAVENFL33880137937
000015580FL1558379537GENERAL DENTISTWILLIAM NERESTANT607 S MISSOURI AVELAKELANDFL33815132834
000018375FL1821006800GENERAL DENTISTNHUNG THANH NONG5535 CYPRESS GARDENS BLVD STE 120WINTER HAVENFL33884131754
000016935FL1023160637ENDODONTISTHAIDER ALZUBAIDI3003 S FLORIDA AVE STE 101LAKELANDFL33803128603
000006787FL1043524655GENERAL DENTISTTHOMAS A FELLNER24174 HWY 27 STE 200LAKE WALESFL33859125780
000019011FL1598842270PEDIATRIC DENTISTERIN SMITH BERLING5710 US HIGHWAY 98 NLAKELANDFL338091231194
000006080FL1689743825GENERAL DENTISTKENNETH L MUNDY4326 HIGHLAND PARK BLVDLAKELANDFL33813121557
000018539FL1922082486ORAL SURGEONJOSE LUIS LEON RAMIREZ400 AVENUE K SE STE 14AWINTER HAVENFL33880120405
000012653FL1720121510PERIODONTISTJEFFRY D BARNES320 AVENUE K SE STE 1WINTER HAVENFL33880119355
000013330FL1336231117GENERAL DENTISTFARID MOGHADASI5608 US HIGHWAY 98 NLAKELANDFL33809119471
000014269FL1851413991PERIODONTISTDAVID A CAMPBELL3003 S FLORIDA AVE STE 201LAKELANDFL33803118367
000012434FL1316169790PEDIATRIC DENTISTSHIRIN YASREBI2015 E EDGEWOOD DRLAKELANDFL33803114906
000014558FL1356435473GENERAL DENTISTLEA D WHEELER4406 S FLORIDA AVE STE 29LAKELANDFL33813110579
000008002FL1144652868GENERAL DENTISTCHARLES R FORT330 E BROADWAY STFORT MEADEFL33841110509
000007070FL1558484881GENERAL DENTISTWILLIAM F CARDMAN4455 FLORIDA NATIONAL DRLAKELANDFL33813107693
000015138FL1285654046GENERAL DENTISTERIC L EBUEN4204 US HIGHWAY 98 NLAKELANDFL33809105900
000017859FL1922244722GENERAL DENTISTJENNIFER O MARINO1375 TOWN CENTER DRLAKELANDFL33803103927
000010646FL1407879687GENERAL DENTISTJENNIFER M STIDHAM620 E DAVIDSON STBARTOWFL33830102574
000008151FL1942345699GENERAL DENTISTJOHN B ELLIS115 E PALM DR STE 1LAKELANDFL33803101458
000015279FL1194841239ORAL SURGEONRIGO CORNEJO400 AVENUE K SE STE 14AWINTER HAVENFL3388093408
000016294FL1902098247GENERAL DENTISTGERALD V CERDAN501 E CENTRAL AVEWINTER HAVENFL3388093464
000015652FL1396843330GENERAL DENTISTMASSIMILIANO FORNI701 STATE ROAD 60 ELAKE WALESFL3385391375
000014466FL1811000698ORAL SURGEONEDWARD J MESZAROS1736 E EDGEWOOD DRLAKELANDFL3380384324
000017773FL1477717627GENERAL DENTISTJEROME CERDAN501 E CENTRAL AVEWINTER HAVENFL3388084379
000007870FL1477501120GENERAL DENTISTROBERT K HULEN226 DOMARIS AVELAKE WALESFL3385384254
000008256FL1770591067GENERAL DENTISTPAUL S SAARI5050 S LAKELAND DRLAKELANDFL3381381353
000006425FL1568493187GENERAL DENTISTCHARLES D LLANO320 W HIGHLAND DRLAKELANDFL3381379367
000012177FL1487714788ENDODONTISTSTEVEN C MCNUTT320 AVENUE K SE STE 2WINTER HAVENFL338807796
000012501FL1609825108GENERAL DENTISTHECTOR A GONZALEZ23871 HWY 27LAKE WALESFL3385977433
000008413FL1922157619GENERAL DENTISTFREDERICK D THURSTON308 E PARK STAUBURNDALEFL3382375509
000006458FL1346328812GENERAL DENTISTALAN SIZEMORE501 E CENTRAL AVEWINTER HAVENFL3388075286
000017004FL1366705790GENERAL DENTISTCHRISTOPHER S NOWACKI1202 MILLENNIUM PKWYBRANDONFL3351173670
000017171FL1295754018GENERAL DENTISTRASSEL EL HAMARAH1020 5TH ST SEWINTER HAVENFL3388072541
000010671FL1538351556GENERAL DENTISTEDWARD J WILLIAMS6958 SHIMMERING DRLAKELANDFL3381372552
000019817FL1497917363GENERAL DENTISTTORI STEELE GRIEB2222 E COUNTY ROAD 540ALAKELANDFL3381371575
000014393FL1922378785GENERAL DENTISTSTEVE G WANG329 CYPRESS GARDENS BLVDWINTER HAVENFL3388070496
000010460FL1417279217GENERAL DENTISTJAMES E CARROLL2156 HARDEN BLVDLAKELANDFL3380370295
000014475FL1093820995GENERAL DENTISTJOHN I PARK400 AVENUE K SE STE 12WINTER HAVENFL3388069336
000006914FL1730230541GENERAL DENTISTANDREW MCKEVENY4145 US HIGHWAY 98 NLAKELANDFL3380965282
000013748FL1811976608GENERAL DENTISTBRIAN TATE CROSBY2154 HARDEN BLVDLAKELANDFL3380364378
000014297FL1063632214GENERAL DENTISTSIMON FIRER7375 US HIGHWAY 98 NLAKELANDFL3380962266
000014673FL1215072947PROSTHODONTISTELA M TORRES-MOORE200 AVENUE K SE STE 4WINTER HAVENFL3388062265
000018111FL1730118043GENERAL DENTISTJOSE G CRUZ6390 CYPRESS GARDENS BLVDWINTER HAVENFL3388460338
000009290FL1982607974GENERAL DENTISTDAVID W MURCHISON JR200 AVENUE K SE STE 4WINTER HAVENFL3388060231
000006817FL1609959873GENERAL DENTISTGERALD W GRINER200 AVENUE K SE # 1WINTER HAVENFL3388058249
000010135FL1851323976GENERAL DENTISTSTEVEN D REDDICK440 S BUCKMOORE RDLAKE WALESFL3385358278
000012365FL1962620815PEDIATRIC DENTISTNANCY MONTGOMERY-WARE225 IMPERIAL BLVD # 3LAKELANDFL3380358413
000017709FL1760611412GENERAL DENTISTOMAYRA TORRES7700 LAKE WILSON RDDAVENPORTFL3389658307
000019132FL1851479265GENERAL DENTISTKIMBERLY LYNN BOYETT3615 S FLORIDA AVE STE 850LAKELANDFL3380356405
000016109FL1578696100GENERAL DENTISTMARIELA K LUNG5055 S LAKELAND DRLAKELANDFL3381353326
000016986FL1265607535GENERAL DENTISTJOSE F LOPEZ2300 DEER CREEK COMMERCE LN STE 500DAVENPORTFL3383753248
000016646FL1164574679GENERAL DENTISTANDREW P AGNINI1805 LAKELAND HILLS BLVDLAKELANDFL3380552346
000007401FL1619012887ORAL SURGEONHARLEY M RICHARDS2150 HARDEN BLVDLAKELANDFL3380352201
000018683FL1306932454GENERAL DENTISTBLANCA L FERNANDEZ5163 US HWY 98 SLAKELANDFL3381252391
000009999FL1881763993GENERAL DENTISTGEORGE W BUTZ III1517 3RD ST SEWINTER HAVENFL3388052243
000012942FL1821273731GENERAL DENTISTRAYMOND M PARRA2213 NORTH BLVD WDAVENPORTFL3383750235
000006404FL1336158674GENERAL DENTISTTHOMAS R JOHNSON3265 CYPRESS GARDENS RDWINTER HAVENFL3388450261
000018829FL1023225463GENERAL DENTISTJEFFREY A MARTIN2153 E COUNTY ROAD 540ALAKELANDFL3381350334
000015917FL1669512182GENERAL DENTISTMATTHEW AGNINI1805 LAKELAND HILLS BLVDLAKELANDFL3380549259
000011835FL1538200282GENERAL DENTISTJAMES CLAYTON LANHAM115 E PALM DRLAKELANDFL3380348323
000013303FL1407960461GENERAL DENTISTCHRISTOPHER P LODENQUAI117 KERNEYWOOD STLAKELANDFL3380348248
000010592FL1902001035GENERAL DENTISTDWIGHT H PATE306 PILAKLAKAHA AVEAUBURNDALEFL3382347234
000018127FL1952408155PROSTHODONTISTCARLOS A POLO-MONTES6390 CYPRESS GARDENS BLVDWINTER HAVENFL3388446283
000006930FL1386673697ORAL SURGEONLAWRENCE B MUSSER2150 HARDEN BLVDLAKELANDFL3380344154
000013085FL1730324690GENERAL DENTISTCLAUDE A HEARN296 1ST ST NWINTER HAVENFL3388144283
000005964FL1013926377GENERAL DENTISTMICHAEL F AGNINI1805 LAKELAND HILLS BLVDLAKELANDFL3380544230
000008439FL1689898025GENERAL DENTISTRONALD L JAMES2024 EDGEWOOD DR S STE 2LAKELANDFL3380344174
000020162FL1689629248GENERAL DENTISTNICOLE SENSABAUGH3436 S FLORIDA AVE #100LAKELANDFL3380343246
000016643FL1184842908GENERAL DENTISTHENRY ACOSTA2016 US HIGHWAY 92 WAUBURNDALEFL3382342265
000007426FL1497956122GENERAL DENTISTRANDY P JONES4335 HIGHLAND PARK BLVDLAKELANDFL3381342294
000020257FL1922015874GENERAL DENTISTKYLE ALLEN YERTON2222 E COUNTY ROAD 540ALAKELANDFL3381340280
000006723FL1629418843PERIODONTISTJAMES M BELCHER3003 S FLORIDA AVE STE 201LAKELANDFL3380339108
000017074FL1588767040GENERAL DENTISTWILLIAM A MUELLER III3845 S FLORIDA AVELAKELANDFL3381338319
000011013FL1255472387GENERAL DENTISTANTHONY I WONG330 S LAKE SHORE WAYLAKE ALFREDFL3385038198
000020272FL1164642153GENERAL DENTISTMARYAM BANGESH24185 HWY 27LAKE WALESFL3385936224
000016500FL1982809539ENDODONTISTTERRYL M CRAWFORD1602 S FLORIDA AVELAKELANDFL3380335228
000012379FL1912151838GENERAL DENTISTPAUL ALLEN PALO151 AVENUE F NWWINTER HAVENFL3388135252
000016468FL1437276300ENDODONTISTMALISSA VACHARAKIAT1008 5TH SE STWINTER HAVENFL3388034172
000017075FL1346309747GENERAL DENTISTKAWVEH NOFALLAH3624 HARDEN BLVDLAKELANDFL3380334225
000004587FL1306850037GENERAL DENTISTDAVID W GOLDSTON120 CARTER BLVD STE 7POLK CITYFL3386834458

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