Active NPI
Donald Van, DDS
- Dentist
- Jacksonville, FL
National Provider Identifier
1114367471
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN20242
- Practice address
- 1036-42 Dunn Ave
Jacksonville, FL 32218-6359 - Phone
- (954) 790-2091
- NPI assigned
- Jul 2, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN20242 | FL | Primary |
Addresses
Primary practice location
1036-42 Dunn Ave
Jacksonville, FL 32218-6359
Mailing address
2325 SW 185TH Ave
Miramar, FL 33029-5904
Phone (954) 790-2091
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150604002135 | FL | Order and Referring Only - Other (Physician) | 5799006573 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN20242 | FL | MD | Dentist |
Networks
- Freedom Health HMO Network
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1372723200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1373500800000",
"number": "1114367471",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2325 SW 185TH AVE",
"city": "MIRAMAR",
"state": "FL",
"postal_code": "330295904",
"telephone_number": "954-790-2091"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1036-42 DUNN AVE",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322186359",
"telephone_number": "954-790-2091"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN",
"first_name": "DONALD",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-07-02",
"last_updated": "2013-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "DN20242",
"primary": true
}
],
"identifiers": [],
"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 Jul 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.