Ponte Vedra Pediatric Dentistry and Orthodontics

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DN18271 Issued in FL

Legal business name

PONTE VEDRA PEDIATRIC DENTISTRY AND ORTHODONTICS

Practice address

480 Town Plaza Avenue
Suite 110
Ponte Vedra, FL 32081

Phone

(904) 880-5437

Fax

(904) 880-1490

NPI assigned

Aug 19, 2015

Organization subpart

No

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

Authorized official

Name

Mrs. Lindsay G. Maples, DMD

Title

Owner

Phone

(904) 880-5437

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1439942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439942400000",
    "number": "1194191692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "480 TOWN PLAZA AVENUE",
            "address_2": "SUITE 110",
            "city": "PONTE VEDRA",
            "state": "FL",
            "postal_code": "32081",
            "telephone_number": "904-880-5437",
            "fax_number": "904-880-1490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "480 TOWN PLAZA AVENUE",
            "address_2": "SUITE 110",
            "city": "PONTE VEDRA",
            "state": "FL",
            "postal_code": "32081",
            "telephone_number": "904-880-5437",
            "fax_number": "904-880-1490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PONTE VEDRA PEDIATRIC DENTISTRY AND ORTHODONTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-19",
        "last_updated": "2015-08-19",
        "status": "A",
        "authorized_official_last_name": "MAPLES",
        "authorized_official_first_name": "LINDSAY",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-880-5437",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "FL",
            "license": "DN18271",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ponte Vedra Hearing Associates, LLC
• Ponte Vedra Speech Language and Learning LLC
• Ponte Vedra Speech Language and Learning LLC
• Ponte Vedra Speech Therapy LLC
• Cody Randall Pontius, MED, ATC, LAT
• Prevail Therapy Services, LLC

• Pediatric Dentistry in Ponte Vedra, FL
• Providers in Ponte Vedra, FL by specialty
• Pediatric Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2015; 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.