Pensacola Patriot Dental PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

PENSACOLA PATRIOT DENTAL PLLC

Doing business as

Patriot Dental

Practice address

4627 N Davis Hwy Ste a
Pensacola, FL 32503-2364

Phone

(850) 477-1120

NPI assigned

Aug 6, 2021

Last updated

Aug 6, 2021By 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. John Keith Lisonbee, DMDNPI 1528685070

Title

Ceo

Phone

(850) 758-1844

Specialties & licenses 1

Addresses

Other names 1

• Patriot Dental Doing business as

Locations

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.

• John Keith Lisonbee, DMD

  • General Practice Dentistry
  • Pensacola, FL
  • NPI 1528685070
  NPD Authorized official
• Deck Franklin Couch, D.D.S.

  • Periodontics
  • Pensacola, FL
  • NPI 1417190950
  NPD (past)
• Dan B. Henry, DDS

  • General Practice Dentistry
  • Pensacola, FL
  • NPI 1932279122
  NPD (past)

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

{
    "created_epoch": "1628208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628208000000",
    "number": "1629742226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4627 N DAVIS HWY STE A",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325032364",
            "telephone_number": "850-477-1120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4627 N DAVIS HWY STE A",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325032364",
            "telephone_number": "850-477-1120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENSACOLA PATRIOT DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-06",
        "last_updated": "2021-08-06",
        "certification_date": "2021-08-06",
        "status": "A",
        "authorized_official_last_name": "LISONBEE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "KEITH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "850-758-1844",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Patriot Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Pensacola Pediatrics PA
• Pensacola Pediatrics, PA
• Pensacola Pediatrics, PA
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• Pensacola Pelvic Health, LLC

• Dental Clinic/Center in Pensacola, FL
• Providers in Pensacola, FL by specialty
• Dental Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2021; 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.