Organization Active NPI

Atlantic Dentistry PA

  • General Practice Dentistry
  • Jacksonville, FL
National Provider Identifier
1043792534
Registry record updated Aug 31, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
ATLANTIC DENTISTRY PA
Practice address
13474 Atlantic Blvd Ste 109
Jacksonville, FL 32225-0100
Phone
(904) 647-1800
Fax
(904) 647-1802
NPI assigned
Aug 31, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2018

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

Authorized official

Name
Sara Bastos
Title
Office Manager
Phone
(904) 647-1800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

13474 Atlantic Blvd Ste 109
Jacksonville, FL 32225-0100

Mailing address

13474 Atlantic Blvd Ste 109
Jacksonville, FL 32225-0100
Phone (904) 647-1800

National Provider Directory

National Provider Directory

Locations

13474 Atlantic Blvd
Ste 109
Jacksonville, FL 32225
Phone (904) 647-1800

Practitioners & affiliated clinicians

Practitioners 1

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": "1535673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1535673600000",
    "number": "1043792534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13474 ATLANTIC BLVD STE 109",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322250100",
            "telephone_number": "904-647-1800",
            "fax_number": "904-647-1802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13474 ATLANTIC BLVD STE 109",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322250100",
            "telephone_number": "904-647-1800",
            "fax_number": "904-647-1802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATLANTIC DENTISTRY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-31",
        "last_updated": "2018-08-31",
        "status": "A",
        "authorized_official_last_name": "BASTOS",
        "authorized_official_first_name": "SARA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "904-647-1800"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2018; 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.