NPIMap

Organization Active NPI

Medicaid Dentistry of Daytona LLC

  • Pediatric Dentistry
  • Daytona Beach, FL
National Provider Identifier
1326470436
Registry record updated May 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
DN13783 Issued in FL
Legal business name
MEDICAID DENTISTRY OF DAYTONA LLC
Practice address
1021 South Ridgewood Ave
Daytona Beach, FL 32114
Phone
(386) 304-2677
Fax
(386) 304-1899
NPI assigned
Jul 31, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2018

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

Authorized official

Name
Mr. Mubashir Chaudhry, DMD
Title
Owner
Phone
(386) 304-2677

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X FL
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X DN13783 FL Primary
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X DN18742 FL

Addresses

Primary practice location

1021 South Ridgewood Ave
Daytona Beach, FL 32114

Mailing address

1021 South Ridgewood Ave
Daytona Beach, FL 32114
Phone (386) 304-2677

Other names 1

  • Daytona Pediatric Dentistry Other name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1375228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526860800000",
    "number": "1326470436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 SOUTH RIDGEWOOD AVE",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "32114",
            "telephone_number": "386-304-2677",
            "fax_number": "386-304-1899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 SOUTH RIDGEWOOD AVE",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "32114",
            "telephone_number": "386-304-2677",
            "fax_number": "386-304-1899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAID DENTISTRY OF DAYTONA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-31",
        "last_updated": "2018-05-21",
        "status": "A",
        "authorized_official_last_name": "CHAUDHRY",
        "authorized_official_first_name": "MUBASHIR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "386-304-2677",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "FL",
            "license": "DN13783",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "FL",
            "license": "DN18742",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Daytona Pediatric Dentistry",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Daytona Pediatric Dentistry",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Daytona Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2018; 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.