Individual provider Active NPI

John Vallilee, DMD

  • Dentist
  • Key West, FL
National Provider Identifier
1043989098
Registry record updated Jun 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN28309 Issued in FL
Practice address
1721 Flagler Ave
Key West, FL 33040-4926
Phone
(305) 294-6696
NPI assigned
Sep 12, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DS043375 PA
Dentist 122300000X DN28309 FL Primary

Addresses

Primary practice location

1721 Flagler Ave
Key West, FL 33040-4926

Mailing address

1721 Flagler Ave
Key West, FL 33040-4926
Phone (305) 294-6696

Other practice location 1

100 Continental Dr
Elizabethtown, PA 17022-2260
Phone (717) 367-1336

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250409001422 FL Practitioner - Dentist 6103340385 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DN28309FLMDDentist
DS043375PAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Rural Health Network of Monroe County, Florida, Inc. CurrentSince Mar 4, 2025 Accepting new patients
Artistic Smiles, P.a. CurrentSince Oct 12, 2025 Accepting new patients
Island Dental Associates, P. a. PastSince Jun 8, 2025 Accepting new patients
Rural Health Network of Monroe County, Florida, Inc. Past Accepting new patients

Locations

3706 N Roosevelt Blvd
Ste D
Key West, FL 33040
Phone (305) 517-6613

3706 N Roosevelt Blvd
Ste G
Key West, FL 33040
Phone (305) 517-6613

1721 Flagler Ave
Key West, FL 33040
Phone (305) 294-6696

3706 N Roosevelt Blvd
Ste C
Key West, FL 33040
Phone (305) 295-6790

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1631404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748822400000",
    "number": "1043989098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1721 FLAGLER AVE",
            "city": "KEY WEST",
            "state": "FL",
            "postal_code": "330404926",
            "telephone_number": "305-294-6696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1721 FLAGLER AVE",
            "city": "KEY WEST",
            "state": "FL",
            "postal_code": "330404926",
            "telephone_number": "305-294-6696"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Continental Dr",
            "address_purpose": "LOCATION",
            "city": "Elizabethtown",
            "state": "PA",
            "postal_code": "170222260",
            "country_code": "US",
            "telephone_number": "717-367-1336",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VALLILEE",
        "first_name": "JOHN",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-09-12",
        "last_updated": "2025-06-02",
        "certification_date": "2025-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS043375",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN28309",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Key West, FL

Sources for this page

Verify at the official NPI Registry.