Avalon Dental Clinic PL

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN15481 Issued in FL

Legal business name

AVALON DENTAL CLINIC PL

Practice address

4272 Avalon Boulevard
Milton, FL 32583-2858

Phone

(850) 626-6100

Fax

(850) 626-6161

NPI assigned

Mar 1, 2006

Last updated

Aug 22, 2020By 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. Anissa Marie Rodriquez-Ottley, DMD

Title

Owner

Phone

(850) 626-6100

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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.

• Mike H Marcantonio, DMD

  • General Practice Dentistry
  • Milton, FL
  • NPI 1508077397
  NPD (past)
• Anissa R Ottley, DMD

  • General Practice Dentistry
  • Milton, FL
  • NPI 1013128867
  NPD (past)

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

{
    "created_epoch": "1141171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1629045489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4272 AVALON BOULEVARD",
            "city": "MILTON",
            "state": "FL",
            "postal_code": "325832858",
            "telephone_number": "850-626-6100",
            "fax_number": "850-626-6161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4272 AVALON BOULEVARD",
            "city": "MILTON",
            "state": "FL",
            "postal_code": "325832858",
            "telephone_number": "850-626-6100",
            "fax_number": "850-626-6161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVALON DENTAL CLINIC PL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RODRIQUEZ-OTTLEY",
        "authorized_official_first_name": "ANISSA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "850-626-6100",
        "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": "DN15481",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cynthia Ard
• Holly R Arland, MS
• Rebecca Ates, NP
• Dennis Umali Atienza, DO
• Kathleen Lynn Atwill
• Angela Marie Avery, LMHC
• Jocquelynn Michele Bailey
• Henry Nash Baker III, PHARMD
• Justin Dean Baker
• Kim Baker

• General Practice Dentistry in Milton, FL
• Providers in Milton, 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 Aug 22, 2020; 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.