Valley Ridge Pediatric Dentistry

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

VALLEY RIDGE PEDIATRIC DENTISTRY

Practice address

4220 Valley Ridge Blvd Ste 4
Ponte Vedra, FL 32081-5172

Phone

(352) 262-0968

NPI assigned

May 1, 2024

Organization subpart

No

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

Authorized official

Name

Dr. Ryan Clance, D.M.D.

Title

President

Phone

(352) 262-0968

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1714521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714521600000",
    "number": "1093562787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2003 GREY FALCON CIR SW",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329628616",
            "telephone_number": "352-262-0968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4220 VALLEY RIDGE BLVD STE 4",
            "city": "PONTE VEDRA",
            "state": "FL",
            "postal_code": "320815172",
            "telephone_number": "352-262-0968"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALLEY RIDGE PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-01",
        "last_updated": "2024-05-01",
        "certification_date": "2024-05-01",
        "status": "A",
        "authorized_official_last_name": "CLANCE",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "352-262-0968",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Dentistry in Ponte Vedra, FL
• Providers in Ponte Vedra, FL by specialty
• Pediatric Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2024; 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.