NPIMap

Organization Active NPI

My Dentist and Associates, P.a.

  • General Practice Dentistry
  • Jacksonville, FL
National Provider Identifier
1518176023
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN13413 Issued in FL
Legal business name
MY DENTIST AND ASSOCIATES, P.A.
Practice address
12220 Atlantic Blvd
Suite #128
Jacksonville, FL 32225-5822
Phone
(904) 221-8221
NPI assigned
May 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Yong Park
Title
President
Phone
(904) 221-8221

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X DN13413 FL Primary

Addresses

Primary practice location

12220 Atlantic Blvd
Suite #128
Jacksonville, FL 32225-5822

Mailing address

12220 Atlantic Blvd
Suite #128
Jacksonville, FL 32225-5822

National Provider Directory

National Provider Directory

Locations

12220 Atlantic Blvd
Ste 128
Jacksonville, FL 32225
Phone (904) 221-8221

NPI Registry JSON

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

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1518176023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12220 ATLANTIC BLVD",
            "address_2": "SUITE #128",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322255822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12220 ATLANTIC BLVD",
            "address_2": "SUITE #128",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322255822",
            "telephone_number": "904-221-8221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MY DENTIST AND ASSOCIATES, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "YONG",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-221-8221",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN13413",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.