NPIMap

Organization Active NPI

Emerald Coast Periodontics

  • Periodontics
  • Niceville, FL
National Provider Identifier
1306223888
Registry record updated May 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
DN21004 Issued in FL
Legal business name
EMERALD COAST PERIODONTICS
Practice address
719 Bayshore Drive
Niceville, FL 32578
Phone
(850) 678-6485
NPI assigned
May 4, 2015
Last updated
May 4, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2015

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

Authorized official

Name
Martin M Woolsey, DDSNPI 1588914543
Title
Periodontist
Phone
(850) 678-6485

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Periodontics 1223P0300X DN21004 FL Primary

Addresses

Primary practice location

719 Bayshore Drive
Niceville, FL 32578

Mailing address

719 Bayshore Drive
Niceville, FL 32578

National Provider Directory

National Provider Directory

Locations

719 Bayshore Dr
Niceville, FL 32578
Phone (850) 240-1455

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1430697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430697600000",
    "number": "1306223888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "719 BAYSHORE DRIVE",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "32578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "719 BAYSHORE DRIVE",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "32578",
            "telephone_number": "850-678-6485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMERALD COAST PERIODONTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-04",
        "last_updated": "2015-05-04",
        "status": "A",
        "authorized_official_last_name": "WOOLSEY",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PERIODONTIST",
        "authorized_official_telephone_number": "850-678-6485",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "FL",
            "license": "DN21004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Niceville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 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.