Tuscawilla Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN15207 Issued in FL

Legal business name

TUSCAWILLA DENTAL LLC

Practice address

2102 S Ridgewood Ave
Ste 6
Edgewater, FL 32141-4240

Phone

(386) 423-3652

Fax

(386) 423-3653

NPI assigned

Apr 29, 2008

Last updated

Apr 29, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. David Richard McCreary, DMD

Title

Owner

Phone

(386) 423-3652

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1209427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209427200000",
    "number": "1598930646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2102 S RIDGEWOOD AVE",
            "address_2": "STE 6",
            "city": "EDGEWATER",
            "state": "FL",
            "postal_code": "321414240",
            "telephone_number": "386-423-3652",
            "fax_number": "386-423-3653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2102 S RIDGEWOOD AVE",
            "address_2": "STE 6",
            "city": "EDGEWATER",
            "state": "FL",
            "postal_code": "321414240",
            "telephone_number": "386-423-3652",
            "fax_number": "386-423-3653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TUSCAWILLA DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-29",
        "last_updated": "2008-04-29",
        "status": "A",
        "authorized_official_last_name": "MCCREARY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "386-423-3652",
        "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": "DN15207",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alpheus Thompson III
• Jonathan Michael Treece, M.D.
• Philp M Tremblay, PT
• Jeffrey A True, M.D
• Jackson Brooks Turner, MD
• Connie Vandervelde, MSW
• Gilberto Vega-Martinez, MD, PT
• Stephen Charles Viel, M.D.
• Virtuoso Counseling Services, LLC
• Carmen Michele Virtuoso, LCSW

• General Practice Dentistry in Edgewater, FL
• Providers in Edgewater, 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 29, 2008; 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.