NPIMap

Organization Active NPI

Ponte Vedra Cosmetic Dentistry, PA

  • General Practice Dentistry
  • Ponte Vedra Beach, FL
National Provider Identifier
1396000329
Registry record updated Jul 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
PONTE VEDRA COSMETIC DENTISTRY, PA
Practice address
100 Professional Dr
Ponte Vedra Beach, FL 32082-6216
Phone
(904) 285-8407
Fax
(904) 285-5346
NPI assigned
Jul 5, 2012
Last updated
Jul 5, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2012

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

Authorized official

Name
Mrs. Kamala Rudolph
Title
Practice Administrator
Phone
(904) 285-8407

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

100 Professional Dr
Ponte Vedra Beach, FL 32082-6216

Mailing address

100 Professional Dr
Ponte Vedra Beach, FL 32082-6216
Phone (904) 285-8407

National Provider Directory

National Provider Directory
Tax ID family
Ponte Vedra Cosmetic Dentistry PA2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

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": "1341446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341446400000",
    "number": "1396000329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 PROFESSIONAL DR",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320826216",
            "telephone_number": "904-285-8407",
            "fax_number": "904-285-5346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 PROFESSIONAL DR",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320826216",
            "telephone_number": "904-285-8407",
            "fax_number": "904-285-5346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PONTE VEDRA COSMETIC DENTISTRY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-05",
        "last_updated": "2012-07-05",
        "status": "A",
        "authorized_official_last_name": "RUDOLPH",
        "authorized_official_first_name": "KAMALA",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "904-285-8407",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ponte Vedra Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2012; 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.