Ldshane PLLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

LDSHANE PLLC

Doing business as

North Jacksonville Complete Dentistry

Practice address

1566 Dunn Ave
Jacksonville, FL 32218

Phone

(904) 751-4958

Fax

(904) 751-5330

NPI assigned

Oct 10, 2017

Last updated

Oct 10, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Ryan Johnson, DDSNPI 1285084459

Title

Owner

Phone

(904) 751-4958

Specialties & licenses 1

Addresses

Other names 1

• North Jacksonville Complete Dentistry Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ryan Johnson, DDS

  • Dentist
  • Jacksonville, FL
  • NPI 1285084459
  NPD (past) Authorized official

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

{
    "created_epoch": "1507593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507593600000",
    "number": "1013427509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1566 DUNN AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32218",
            "telephone_number": "904-751-4958",
            "fax_number": "904-751-5330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1566 DUNN AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32218",
            "telephone_number": "904-751-4958",
            "fax_number": "904-751-5330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LDSHANE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-10",
        "last_updated": "2017-10-10",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-751-4958",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Jacksonville Complete Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Khanh Le, BCBA
• Khoi M Le, D.M.D

• Dentist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2017; 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.