Active NPI
Welltide Orthodontics LLC
- Orthodontics and Dentofacial Orthopedics Dentistry
- St Augustine, FL
National Provider Identifier
1568370104
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- Legal business name
- WELLTIDE ORTHODONTICS LLC
- Practice address
- 420 Paseo Reyes Dr
St Augustine, FL 32095-8558 - Phone
- (904) 671-6996
- Fax
- (904) 671-7002
- NPI assigned
- Sep 1, 2026
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Susan Sara Podray, DMD, MS
- Title
- Orthodontist
- Phone
- (678) 787-3863
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | Primary |
Addresses
Primary practice location
420 Paseo Reyes Dr
St Augustine, FL 32095-8558
Mailing address
420 Paseo Reyes Dr
St Augustine, FL 32095-8558
Phone (904) 671-6996
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1788220800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1788220800000",
"number": "1568370104",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "420 PASEO REYES DR",
"city": "ST AUGUSTINE",
"state": "FL",
"postal_code": "320958558",
"telephone_number": "904-671-6996",
"fax_number": "904-671-7002"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "420 PASEO REYES DR",
"city": "ST AUGUSTINE",
"state": "FL",
"postal_code": "320958558",
"telephone_number": "904-671-6996",
"fax_number": "904-671-7002"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WELLTIDE ORTHODONTICS LLC",
"organizational_subpart": "NO",
"enumeration_date": "2026-09-01",
"last_updated": "2026-09-01",
"certification_date": "2026-09-01",
"status": "A",
"authorized_official_last_name": "PODRAY",
"authorized_official_first_name": "SUSAN",
"authorized_official_middle_name": "SARA",
"authorized_official_title_or_position": "ORTHODONTIST",
"authorized_official_telephone_number": "678-787-3863",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "DMD, MS"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Augustine, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.