Individual provider Active NPI

Brandon R Canaday, DMD

  • Dentist
  • Palm Coast, FL
National Provider Identifier
1336879535
Registry record updated Jun 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN27075 Issued in FL
Practice address
4873 Belle Terre Pkwy
Palm Coast, FL 32137-8696
Phone
(386) 864-8313
NPI assigned
Jun 13, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Dentist 122300000X DN27075 FL Primary

Addresses

Primary practice location

4873 Belle Terre Pkwy
Palm Coast, FL 32137-8696

Mailing address

6405 Jack Wright Island Rd
Saint Augustine, FL 32092-1910
Phone (904) 521-3899

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DN27075FLMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1655078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655251200000",
    "number": "1336879535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6405 JACK WRIGHT ISLAND RD",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320921910",
            "telephone_number": "904-521-3899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4873 BELLE TERRE PKWY",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321378696",
            "telephone_number": "386-864-8313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANADAY",
        "first_name": "BRANDON",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-13",
        "last_updated": "2022-06-15",
        "certification_date": "2022-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN27075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Coast, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2022; 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.