NPIMap

Organization Active NPI

Midbay Dental PPLC

  • Dentist
  • Niceville, FL
National Provider Identifier
1013376219
Registry record updated Feb 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN14797 Issued in FL
Legal business name
MIDBAY DENTAL PPLC
Practice address
4579 E Highway 20 Ste 210
Niceville, FL 32578-9810
Phone
(850) 897-4200
Fax
(850) 897-4504
NPI assigned
Feb 16, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Justine Konane Chase, DDSNPI 1841210267
Title
Owner
Phone
(850) 897-4200

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X DN14797 FL Primary

Addresses

Primary practice location

4579 E Highway 20 Ste 210
Niceville, FL 32578-9810

Mailing address

4579 E Highway 20 Ste 210
Niceville, FL 32578-9810
Phone (850) 897-4200

Other identifiers 1

IdentifierTypeStateIssuer
1841210267OtherFLINDIVIDUAL

Other names 1

  • Mid Bay Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Mid Bay Dental2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4506 E Highway 20
Ste 100
Niceville, FL 32578
Phone (850) 897-1231

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1455580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643932800000",
    "number": "1013376219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4579 E HIGHWAY 20 STE 210",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325789810",
            "telephone_number": "850-897-4200",
            "fax_number": "850-897-4504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4579 E HIGHWAY 20 STE 210",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325789810",
            "telephone_number": "850-897-4200",
            "fax_number": "850-897-4504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDBAY DENTAL PPLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-16",
        "last_updated": "2022-02-04",
        "certification_date": "2022-02-04",
        "status": "A",
        "authorized_official_last_name": "CHASE",
        "authorized_official_first_name": "JUSTINE",
        "authorized_official_middle_name": "KONANE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "850-897-4200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN14797",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL",
            "identifier": "1841210267",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mid Bay Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Niceville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.