Jacksonville Family Dentistry at Southside, Inc

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

16941 Issued in FL

Legal business name

JACKSONVILLE FAMILY DENTISTRY AT SOUTHSIDE, INC

Practice address

8101 Southside Blvd Ste 8
Jacksonville, FL 32256-8005

Phone

(904) 641-2655

NPI assigned

Oct 17, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Bryan Keith Blankenship, DDS

Title

President

Phone

(904) 210-5348

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1508198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1508198400000",
    "number": "1073024006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 FAIRWAY PARK BLVD UNIT 512",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320822667",
            "telephone_number": "904-210-5348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8101 SOUTHSIDE BLVD STE 8",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322568005",
            "telephone_number": "904-641-2655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSONVILLE FAMILY DENTISTRY AT SOUTHSIDE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-17",
        "last_updated": "2017-10-17",
        "status": "A",
        "authorized_official_last_name": "BLANKENSHIP",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "KEITH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-210-5348",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "FL",
            "license": "16941",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dental Clinic/Center in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Dental Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 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.