Advanced Dental Care (Jacksonville South), PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

ADVANCED DENTAL CARE (JACKSONVILLE SOUTH), PLLC

Practice address

3667 Crown Point Rd
Jacksonville, FL 32257-5956

Phone

(305) 274-2499

NPI assigned

Jun 11, 2016

Last updated

Jun 11, 2016By 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

Ms. Stephanie Gomez

Title

Credentialing Coordinator

Phone

(305) 274-2499

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1465603200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465603200000",
    "number": "1619326477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13195 SW 134TH ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331864461",
            "telephone_number": "305-274-2499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3667 CROWN POINT RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322575956",
            "telephone_number": "305-274-2499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DENTAL CARE (JACKSONVILLE SOUTH), PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-11",
        "last_updated": "2016-06-11",
        "status": "A",
        "authorized_official_last_name": "GOMEZ",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "305-274-2499",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Jacksonville, FL
• Providers in Jacksonville, 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 Jun 11, 2016; 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.