Amando Dental Corporation

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

DN15716 Issued in FL

Legal business name

AMANDO DENTAL CORPORATION

Practice address

4540 Southside Blvd
Suite 801
Jacksonville, FL 32216-5492

Phone

(904) 642-2010

Fax

(904) 642-8282

NPI assigned

Jun 26, 2007

Organization subpart

No

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

Authorized official

Name

Crystal L Less

Title

VP of Operations

Phone

(904) 998-7000

Specialties & licenses 1

Addresses

Other names 1

• Southside Dental at Tinseltown Doing business as

Practitioners 1

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

• Brock Philips, DMD

  • General Practice Dentistry
  • Jacksonville, FL
  • NPI 1699094151
  NPD (past)

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

{
    "created_epoch": "1182816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422230400000",
    "number": "1275739237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3545-1 ST. JOHNS BLUFF RD. S.",
            "address_2": "SUITE 352",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32224",
            "telephone_number": "904-998-7000",
            "fax_number": "904-998-7702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4540 SOUTHSIDE BLVD",
            "address_2": "SUITE 801",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322165492",
            "telephone_number": "904-642-2010",
            "fax_number": "904-642-8282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMANDO DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-26",
        "last_updated": "2015-01-26",
        "status": "A",
        "authorized_official_last_name": "LESS",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "904-998-7000"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "FL",
            "license": "DN15716",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southside Dental at Tinseltown",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alyssha Powers DMD PA
• Alberto Isaac Alzate, MD
• Yusuf Maref Alzoubi
• Haris Aman, DPT
• Amanda Sweat LMHC, PLLC
• Amani Komfort LLC
• Kofi Amanquah
• Shaquita Renee Amanquah, PHARMD
• Ahmed Amara
• Tara Jean Amarante, MS

• Preferred Provider Organization in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Preferred Provider Organization in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 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.