Haeussner Dental Group

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN 6384 Issued in FL

Legal business name

HAEUSSNER DENTAL GROUP

Practice address

1409 Kingsley Ave
BLDG. #11
Orange Park, FL 32073-4562

Phone

(904) 264-2483

Fax

(904) 264-0474

NPI assigned

Mar 28, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Theodore Adrian Haeussner, DMD

Title

President

Phone

(904) 264-2483

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brian David Haeussner, D.M.D.

  • General Practice Dentistry
  • Orange Park, FL
  • NPI 1295968832
  NPD (past)

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1174642375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1409 KINGSLEY AVE",
            "address_2": "BLDG. #11",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734562",
            "telephone_number": "904-264-2483",
            "fax_number": "904-264-0474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1409 KINGSLEY AVE",
            "address_2": "BLDG. #11",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734562",
            "telephone_number": "904-264-2483",
            "fax_number": "904-264-0474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAEUSSNER DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HAEUSSNER",
        "authorized_official_first_name": "THEODORE",
        "authorized_official_middle_name": "ADRIAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-264-2483",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN 6384",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Van Guzman
• Kimberly Marie Gydish-Theobald, M.ED., L.M.H.C.,CAP
• H2 Rehabilitation Services of Florida LLC (H2 Health)
• H2 Therapy Provider Network
• Lena Haddad
• Brian David Haeussner, D.M.D.
• Marcia Haines, ARNP
• Hair Peace of Mind
• Summer Hales
• Carneysha Hall

• General Practice Dentistry in Orange Park, FL
• Providers in Orange Park, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.