Economy Dentistry for Children Children'S General Dentistry , LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN8243 Issued in FL

Legal business name

ECONOMY DENTISTRY FOR CHILDREN CHILDREN'S GENERAL DENTISTRY , LLC

Practice address

1680 Dunn Ave
#31
Jacksonville, FL 32218-4782

Phone

(904) 714-6939

Fax

(904) 751-9196

NPI assigned

Aug 5, 2011

Organization subpart

No

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

Authorized official

Name

Mr. Leroy R Polite, DMD

Title

President

Phone

(904) 714-6939

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1312502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352851200000",
    "number": "1225317423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1680 DUNN AVE",
            "address_2": "#31",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322184782",
            "telephone_number": "904-696-6767",
            "fax_number": "904-696-6833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1680 DUNN AVE",
            "address_2": "#31",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322184782",
            "telephone_number": "904-714-6939",
            "fax_number": "904-751-9196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ECONOMY DENTISTRY FOR CHILDREN CHILDREN'S GENERAL DENTISTRY , LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-05",
        "last_updated": "2012-11-14",
        "status": "A",
        "authorized_official_last_name": "POLITE",
        "authorized_official_first_name": "LEROY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-714-6939",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN8243",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Jacksonville, FL
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2012; 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.