First Coast Periodontics, PA

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

DN11181 Issued in FL

Legal business name

FIRST COAST PERIODONTICS, PA

Practice address

7711 Baymeadows Rd E
Suite 7
Jacksonville, FL 32256-9675

Phone

(904) 807-9825

Fax

(904) 807-9829

NPI assigned

Aug 11, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Walter Robert Lewis Wood, D.M.D.

Title

President

Phone

(904) 807-9825

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1281484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281484800000",
    "number": "1679888952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7711 BAYMEADOWS RD E",
            "address_2": "SUITE 7",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322569675",
            "telephone_number": "904-807-9825",
            "fax_number": "904-807-9829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7711 BAYMEADOWS RD E",
            "address_2": "SUITE 7",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322569675",
            "telephone_number": "904-807-9825",
            "fax_number": "904-807-9829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIRST COAST PERIODONTICS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-11",
        "last_updated": "2010-08-11",
        "status": "A",
        "authorized_official_last_name": "WOOD",
        "authorized_official_first_name": "WALTER",
        "authorized_official_middle_name": "ROBERT LEWIS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-807-9825",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "FL",
            "license": "DN11181",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• First Coast Midwifery Services LLC
• First Coast Nephrology Inc
• First Coast Orthopedic Associates LLC
• First Coast Orthopedic Center, LLC
• First Coast Pathology Associates, LLC
• First Coast Physical Medicine Inc
• First Coast Plastic Surgery PA
• First Coast Podiatric Surgery and Wound Care LLC
• First Coast Podiatry, P a
• First Coast Primary Care Inc

• Dental Clinic/Center in Jacksonville, FL
• Providers in Jacksonville, 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 11, 2010; 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.