NPIMap

Organization Active NPI

Reza Azari Samani, DDS PA

  • Prosthodontics
  • Jacksonville, FL
National Provider Identifier
1114059201
Registry record updated Jun 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
ProsthodonticsTaxonomy code 1223P0700X
License
12860 Issued in FL
Legal business name
REZA AZARI SAMANI, DDS PA
Practice address
14453 Beach Blvd.
Suite 100
Jacksonville, FL 32250
Phone
(904) 992-8900
Fax
(904) 992-4922
NPI assigned
Mar 12, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2014

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

Authorized official

Name
Reza Azari Samani, DDS
Title
Owner
Phone
(904) 992-8900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ProsthodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0700X 12860 FL Primary

Addresses

Primary practice location

14453 Beach Blvd.
Suite 100
Jacksonville, FL 32250

Mailing address

14453 Beach Blvd.
Suite 100
Jacksonville, FL 32250
Phone (904) 992-8900

Other identifiers 2

IdentifierTypeStateIssuer
69855OtherBLUE CROSS BLUE SHIELD
826747OtherUNITED CONCORDIA

National Provider Directory

National Provider Directory

Locations

14453 Beach Blvd
Ste 100
Jacksonville, FL 32250
Phone (904) 992-8900

Practitioners & affiliated clinicians

Practitioners 2

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": "1173657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402272000000",
    "number": "1114059201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14453 BEACH BLVD.",
            "address_2": "SUITE 100",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32250",
            "telephone_number": "904-992-8900",
            "fax_number": "904-992-4922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14453 BEACH BLVD.",
            "address_2": "SUITE 100",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32250",
            "telephone_number": "904-992-8900",
            "fax_number": "904-992-4922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REZA AZARI SAMANI, DDS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-12",
        "last_updated": "2014-06-09",
        "status": "A",
        "authorized_official_last_name": "SAMANI",
        "authorized_official_first_name": "REZA",
        "authorized_official_middle_name": "AZARI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-992-8900",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Prosthodontics",
            "state": "FL",
            "license": "12860",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "69855",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "826747",
            "state": null
        }
    ],
    "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 Jun 9, 2014; 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.