NPIMap

Organization Active NPI

Ormond Beach Dental Group

  • Dentist
  • Ormond Beach, FL
National Provider Identifier
1124257175
Registry record updated Nov 8, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN16350 Issued in FL
Legal business name
ORMOND BEACH DENTAL GROUP
Practice address
802A Sterthaus Ave
Ormond Beach, FL 32174-5132
Phone
(877) 676-6631
NPI assigned
Jul 13, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2013

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

Authorized official

Name
Dr. Kerri A Graham, D.M.D.
Title
Owner/ Dentist
Phone
(877) 676-6631

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X DN16350 FL Primary

Addresses

Primary practice location

802A Sterthaus Ave
Ormond Beach, FL 32174-5132

Mailing address

802A Sterthaus Ave
Ormond Beach, FL 32174-5132
Phone (877) 676-6631

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1247443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383868800000",
    "number": "1124257175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "802A STERTHAUS AVE",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321745132",
            "telephone_number": "877-676-6631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "802A STERTHAUS AVE",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321745132",
            "telephone_number": "877-676-6631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORMOND BEACH DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-13",
        "last_updated": "2013-11-08",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "KERRI",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER/ DENTIST",
        "authorized_official_telephone_number": "877-676-6631",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN16350",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ormond Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2013; 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.