Individual provider Active NPI

Robert Joseph Nemetz, DDS

  • Dentist
  • Jacksonville, FL
National Provider Identifier
1083789283
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN12937 Issued in FL
Practice address
12421 San Jose Blvd
Suite 310
Jacksonville, FL 32223
Phone
(904) 886-4867
Fax
(904) 292-2205
NPI assigned
Nov 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DN12937 FL Primary

Addresses

Primary practice location

12421 San Jose Blvd
Suite 310
Jacksonville, FL 32223

Mailing address

12421 San Jose Blvd
Suite 310
Jacksonville, FL 32223
Phone (904) 886-4867

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
I20160419001893 FL Order and Referring Only - DentistPractitioner - Dentist 5991003303

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DN12937FLMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Nemetz Dental Associates Dentist Past Accepting new patients

Organizations & group practices 1

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": "1164153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1083789283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12421 SAN JOSE BLVD",
            "address_2": "SUITE 310",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32223",
            "telephone_number": "904-886-4867",
            "fax_number": "904-292-2205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12421 SAN JOSE BLVD",
            "address_2": "SUITE 310",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32223",
            "telephone_number": "904-886-4867",
            "fax_number": "904-292-2205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEMETZ",
        "first_name": "ROBERT",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN12937",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.