Brian David Haeussner, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN 18048 Issued in FL

Practice address

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

Phone

(904) 264-2483

Fax

(904) 264-0474

NPI assigned

Aug 31, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Haeussner Dental Group

  • General Practice Dentistry
  • Orange Park, FL
  • NPI 1174642375
  NPD (past)

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

{
    "created_epoch": "1251676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277078400000",
    "number": "1295968832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1409 KINGSLEY AVE",
            "address_2": "#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": "#11",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734562",
            "telephone_number": "904-264-2483",
            "fax_number": "904-264-0474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAEUSSNER",
        "first_name": "BRIAN",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-31",
        "last_updated": "2010-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN 18048",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• 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
• Haeussner Dental Group
• Marcia Haines, ARNP
• Hair Peace of Mind
• Summer Hales
• Carneysha Hall
• Debra Sue Hall, CNM, ARNP

• 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 Jun 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.