Active NPI
Fernando J Haddock, DDS
- Dentist
- Gainesville, FL
National Provider Identifier
1477531234
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 672
- Practice address
- 1395 Center Drive University of Florida
Gainesville, FL 32610-1521 - Phone
- (352) 273-7954
- NPI assigned
- Jan 3, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 672 | FL | Primary |
Addresses
Primary practice location
1395 Center Drive University of Florida
Gainesville, FL 32610-1521
Mailing address
4000 NW 51St St Apt L223
Gainesville, FL 32606-8311
Phone (785) 960-8866
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160316000536 | GA | Order and Referring Only - Dentist | 2163728239 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 672 | FL | MD | Dentist |
Networks
- Freedom Health HMO Network
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136246400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1551916800000",
"number": "1477531234",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4000 NW 51ST ST APT L223",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "326068311",
"telephone_number": "785-960-8866"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1395 CENTER DRIVE UNIVERSITY OF FLORIDA",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "326101521",
"telephone_number": "352-273-7954"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HADDOCK",
"first_name": "FERNANDO",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-01-03",
"last_updated": "2019-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "672",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gainesville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.