NPIMap

Organization Active NPI

Jacksonville Complete Dentistry PLLC

  • Dentist
  • Jacksonville, FL
National Provider Identifier
1194235689
Registry record updated Oct 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
JACKSONVILLE COMPLETE DENTISTRY PLLC
Practice address
7740 Point Meadows Dr
Suites 4 & 5
Jacksonville, FL 32256
Phone
(904) 645-6457
Fax
(904) 645-6459
NPI assigned
Oct 10, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2017

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

Authorized official

Name
Dr. Ryan Johnson, DDS
Title
Owner
Phone
(904) 751-4958

Specialties & licenses 1

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

Addresses

Primary practice location

7740 Point Meadows Dr
Suites 4 & 5
Jacksonville, FL 32256

Mailing address

7740 Point Meadows Dr
Suites 4 & 5
Jacksonville, FL 32256
Phone (904) 645-6457

Other names 1

  • Jacksonville Complete Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

7740 Point Meadows Dr
Ste 4
Jacksonville, FL 32256
Phone (904) 606-6735

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1507593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507593600000",
    "number": "1194235689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7740 POINT MEADOWS DR",
            "address_2": "SUITES 4 & 5",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32256",
            "telephone_number": "904-645-6457",
            "fax_number": "904-645-6459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7740 POINT MEADOWS DR",
            "address_2": "SUITES 4 & 5",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32256",
            "telephone_number": "904-645-6457",
            "fax_number": "904-645-6459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSONVILLE COMPLETE DENTISTRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-10",
        "last_updated": "2017-10-10",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-751-4958",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jacksonville Complete Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Oct 10, 2017; 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.