Guided Smiles Prosthodontics & Implant Center PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

GUIDED SMILES PROSTHODONTICS & IMPLANT CENTER PLLC

Practice address

153 Fort Wade Road
Ste 100
Ponte Vedra, FL 32081

Phone

(904) 395-5501

NPI assigned

Sep 30, 2022

Last updated

Sep 30, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Alonzo Carlos Blackmon, DDSNPI 1821422908

Title

Authorized Official

Phone

(904) 395-5501

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Alonzo Carlos Blackmon, D.D.S, M.S.

  • Prosthodontics
  • Ponte Vedra, FL
  • NPI 1821422908
  NPD Authorized official

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

{
    "created_epoch": "1664496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664496000000",
    "number": "1114641339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "153 FORT WADE ROAD",
            "address_2": "STE 100",
            "city": "PONTE VEDRA",
            "state": "FL",
            "postal_code": "32081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "153 FORT WADE ROAD",
            "address_2": "STE 100",
            "city": "PONTE VEDRA",
            "state": "FL",
            "postal_code": "32081",
            "telephone_number": "904-395-5501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUIDED SMILES PROSTHODONTICS & IMPLANT CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-30",
        "last_updated": "2022-09-30",
        "certification_date": "2022-09-28",
        "status": "A",
        "authorized_official_last_name": "BLACKMON",
        "authorized_official_first_name": "ALONZO",
        "authorized_official_middle_name": "CARLOS",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "904-395-5501",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melinda Faye Greenfield, DO
• Joseph C. Greenhaw, M.D.
• Amy D. Greenwald, M.D.
• Jonathan James Gries, M.D.
• Richard Jay Griffin, RPH
• Tyra Jean Gunn, APRN
• Anjali Gupta, MD
• H2 Rehabilitation Services of Florida LLC
• Erica Manger Hamburger, DC
• Tracy Hannah

• Dental Clinic/Center in Ponte Vedra, FL
• Providers in Ponte Vedra, 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 Sep 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.