NPIMap

Organization Active NPI

Kevon E. Rennie DMD, P.a.

Doing business as Aspen Dental

  • General Practice Dentistry
  • St Augustine, FL
National Provider Identifier
1649633470
Registry record updated Mar 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN21399 Issued in FL
Legal business name
KEVON E. RENNIE DMD, P.A.
Doing business as
Aspen Dental
Practice address
1747 US Highway 1 S
Saint Augustine, FL 32084-4238
Phone
(904) 495-0881
Fax
(904) 824-9257
NPI assigned
Mar 30, 2016
Last updated
Mar 30, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2016

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

Authorized official

Name
Kevon E Rennie, DMD
Title
Owner
Phone
(904) 495-0881

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X DN21399 FL Primary

Addresses

Primary practice location

1747 US Highway 1 S
Saint Augustine, FL 32084-4238

Mailing address

PO Box 3189
Syracuse, NY 13220-3189
Phone (315) 454-6000

Other names 1

  • Aspen Dental Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1459296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459296000000",
    "number": "1649633470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3189",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132203189",
            "telephone_number": "315-454-6000",
            "fax_number": "315-410-5531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1747 US HIGHWAY 1 S",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320844238",
            "telephone_number": "904-495-0881",
            "fax_number": "904-824-9257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEVON E. RENNIE DMD, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-30",
        "last_updated": "2016-03-30",
        "status": "A",
        "authorized_official_last_name": "RENNIE",
        "authorized_official_first_name": "KEVON",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-495-0881",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN21399",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aspen Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Augustine, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 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.