NPIMap

Organization Active NPI

Seabreeze Endodontics, PA

  • Endodontics
  • Niceville, FL
National Provider Identifier
1457914129
Registry record updated Apr 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
Legal business name
SEABREEZE ENDODONTICS, PA
Practice address
4579 E Highway 20 Ste 220
Niceville, FL 32578-9808
Phone
(850) 424-7368
NPI assigned
Apr 18, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2019

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

Authorized official

Name
Dr. Shane Robert Hanson, DMD
Title
President
Phone
(850) 424-7368

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
EndodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223E0200X Primary

Addresses

Primary practice location

4579 E Highway 20 Ste 220
Niceville, FL 32578-9808

Mailing address

4579 E Highway 20 Ste 220
Niceville, FL 32578-9808
Phone (850) 424-7368

National Provider Directory

National Provider Directory

Locations

4579 E Highway 20
Ste 220
Niceville, FL 32578
Phone (850) 424-7368

NPI Registry JSON

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

{
    "created_epoch": "1555545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555545600000",
    "number": "1457914129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4579 E HIGHWAY 20 STE 220",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325789808",
            "telephone_number": "850-424-7368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4579 E HIGHWAY 20 STE 220",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325789808",
            "telephone_number": "850-424-7368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEABREEZE ENDODONTICS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-18",
        "last_updated": "2019-04-18",
        "status": "A",
        "authorized_official_last_name": "HANSON",
        "authorized_official_first_name": "SHANE",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "850-424-7368",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Endodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Niceville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2019; 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.