NPIMap

Organization Active NPI

West Coast Dental Partners

  • General Practice Dentistry
  • Ponte Vedra Beach, FL
National Provider Identifier
1639025356
Registry record updated Mar 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
WEST COAST DENTAL PARTNERS
Practice address
100 Professional Dr
Ponte Vedra Beach, FL 32082-6216
Phone
(904) 285-8407
Fax
(904) 467-3520
NPI assigned
Mar 5, 2026
Last updated
Mar 5, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
WEST COAST DENTAL PARTNERSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 5, 2026

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

Authorized official

Name
Juli Renee Mietzner
Title
Credentialing Manager
Phone
(217) 540-5651

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

100 Professional Dr
Ponte Vedra Beach, FL 32082-6216

Mailing address

100 Professional Dr
Ponte Vedra Beach, FL 32082-6216
Phone (904) 285-8407

National Provider Directory

National Provider Directory
Tax ID family
West Coast Dental Partners59 organizations share this tax ID, including this one
Part of
West Coast Dental Partners

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

100 Professional Dr
Ponte Vedra Beach, FL 32082
Phone (904) 285-8407

NPI Registry JSON

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

{
    "created_epoch": "1772668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772668800000",
    "number": "1639025356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 PROFESSIONAL DR",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320826216",
            "telephone_number": "904-285-8407",
            "fax_number": "904-467-3520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 PROFESSIONAL DR",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320826216",
            "telephone_number": "904-285-8407",
            "fax_number": "904-467-3520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST COAST DENTAL PARTNERS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WEST COAST DENTAL PARTNERS",
        "enumeration_date": "2026-03-05",
        "last_updated": "2026-03-05",
        "certification_date": "2026-03-05",
        "status": "A",
        "authorized_official_last_name": "MIETZNER",
        "authorized_official_first_name": "JULI",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "217-540-5651"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ponte Vedra Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2026; 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.