Yulee Dental PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

YULEE DENTAL PLLC

Practice address

463480 State Road 200
Yulee, FL 32097-3370

Phone

(904) 468-5135

Fax

(407) 574-4651

NPI assigned

Jun 4, 2024

Organization subpart

No

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

Authorized official

Name

Mr. Peter Kelly

Title

Owner

Phone

(407) 432-6224

Specialties & licenses 1

Addresses

Other names 1

• Lofton Creek Dental Doing business as

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

{
    "created_epoch": "1717459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717459200000",
    "number": "1316788359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "463480 STATE ROAD 200",
            "city": "YULEE",
            "state": "FL",
            "postal_code": "320973370",
            "telephone_number": "407-432-6224",
            "fax_number": "407-574-4651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "463480 STATE ROAD 200",
            "city": "YULEE",
            "state": "FL",
            "postal_code": "320973370",
            "telephone_number": "904-468-5135",
            "fax_number": "407-574-4651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YULEE DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-04",
        "last_updated": "2024-06-04",
        "certification_date": "2024-06-04",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "407-432-6224",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lofton Creek Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Glinda Wortham, APRN
• Gerilyn C Worthy-Thayer, PH.D.
• Sarah Elizabeth Wright
• Nathan You, DPT
• Savannah Julia Young
• James Joseph Zielenski, D.C.

• Dental Clinic/Center in Yulee, FL
• Providers in Yulee, FL by specialty
• Dental Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2024; 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.