NPIMap

Organization Active NPI

Podvia and Stanford DMDS

  • General Practice Dentistry
  • Jacksonville, FL
National Provider Identifier
1568560118
Registry record updated May 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN0014583 Issued in FL
Legal business name
PODVIA AND STANFORD DMDS
Practice address
3118 New Berlin Road
Suite 1
Jacksonville, FL 32226
Phone
(904) 765-5573
NPI assigned
Sep 20, 2006
Last updated
May 23, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2013

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

Authorized official

Name
Dr. Kristan Podvia, DMDNPI 1447350988
Title
Dentist
Phone
(904) 765-5573

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X DN0014583 FL Primary

Addresses

Primary practice location

3118 New Berlin Road
Suite 1
Jacksonville, FL 32226

Mailing address

3118 New Berlin Road
Suite 1
Jacksonville, FL 32226
Phone (904) 765-5573

National Provider Directory

National Provider Directory

Locations

3118 New Berlin Rd
Ste 1
Jacksonville, FL 32226
Phone (904) 765-5573

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369267200000",
    "number": "1568560118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3118 NEW BERLIN ROAD",
            "address_2": "SUITE 1",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32226",
            "telephone_number": "904-765-5573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3118 NEW BERLIN ROAD",
            "address_2": "SUITE 1",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32226",
            "telephone_number": "904-765-5573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PODVIA AND STANFORD DMDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2013-05-23",
        "status": "A",
        "authorized_official_last_name": "PODVIA",
        "authorized_official_first_name": "KRISTAN",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "904-765-5573",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN0014583",
            "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 May 23, 2013; 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.