Palm Coast Dental, LLC

Primary specialty

DentistTaxonomy code 122300000X

License

DN17327 Issued in FL

Legal business name

PALM COAST DENTAL, LLC

Practice address

5234 E. Highway 100
Suite 103
Palm Coast, FL 32164

Phone

(386) 263-2936

NPI assigned

May 1, 2009

Last updated

May 1, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Thai Thanh Nong, DMD

Title

Dentist/Owner

Phone

(386) 237-5917

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1241136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1241136000000",
    "number": "1356585566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5234 E. HIGHWAY 100",
            "address_2": "SUITE 103",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "32164",
            "telephone_number": "386-263-2936",
            "fax_number": "386-263-2941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5234 E. HIGHWAY 100",
            "address_2": "SUITE 103",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "32164",
            "telephone_number": "386-263-2936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALM COAST DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-01",
        "last_updated": "2009-05-01",
        "status": "A",
        "authorized_official_last_name": "NONG",
        "authorized_official_first_name": "THAI",
        "authorized_official_middle_name": "THANH",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "386-237-5917",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN17327",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2009; 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.