Jenna Rose Obeng, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN24121 Issued in FL

Practice address

3949 S Nova Rd
Port Orange, FL 32127-4910

Phone

(386) 761-9440

NPI assigned

Jun 5, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• L & L DB, LLC

  dba Dental USA

  • Dental Clinic/Center
  • Daytona Beach, FL
  • NPI 1780172791
  NPD (past)

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

{
    "created_epoch": "1559692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681257600000",
    "number": "1548828346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 CHELSEA PLACE AVE",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321740687",
            "telephone_number": "904-233-3559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3949 S NOVA RD",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321274910",
            "telephone_number": "386-761-9440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OBENG",
        "first_name": "JENNA",
        "middle_name": "ROSE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-05",
        "last_updated": "2023-04-12",
        "certification_date": "2023-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN24121",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Nusbaum
• Stacy A O'Brien, AU.D.
• Steven Christopher James O'Keefe, PHARMACIST
• Pamela O'Neill
• Lacee O'Shea, BCBA
• Ocean Park Wellness LLC
• Makayla Ann Okeefe, CAP
• Tracy Oler, PA-C
• Nicole Olin
• Kristi Oliver

• General Practice Dentistry in Port Orange, FL
• Providers in Port Orange, 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 Apr 12, 2023; 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.

Verify at the official NPI Registry.