Summerfield Family Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN17531 Issued in FL

Legal business name

SUMMERFIELD FAMILY DENTAL

Practice address

11319 Big Bend Rd
Riverview, FL 33569-7183

Phone

(813) 677-4080

Fax

(813) 677-4064

NPI assigned

May 14, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Marc Roy Johnson, DMD

Title

Partner

Phone

(813) 677-4080

Specialties & licenses 3

Addresses

Locations

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

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186012800000",
    "number": "1487869202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11319 BIG BEND RD",
            "city": "RIVERVIEW",
            "state": "FL",
            "postal_code": "335697183",
            "telephone_number": "813-677-4080",
            "fax_number": "813-677-4064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11319 BIG BEND RD",
            "city": "RIVERVIEW",
            "state": "FL",
            "postal_code": "335697183",
            "telephone_number": "813-677-4080",
            "fax_number": "813-677-4064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMERFIELD FAMILY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-14",
        "last_updated": "2007-08-02",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MARC",
        "authorized_official_middle_name": "ROY",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "813-677-4080",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN15183",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN17531",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN16752",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Riverview, FL
• Providers in Riverview, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2007; 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.