NPIMap

Organization Active NPI

Marietta Dental Group

  • General Practice Dentistry
  • Jacksonville, FL
National Provider Identifier
1679972665
Registry record updated Jan 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN15716 Issued in FL
Legal business name
MARIETTA DENTAL GROUP
Practice address
8209 W. Beaver St.
Suite 100
Jacksonville, FL 32220
Phone
(904) 998-7000
Fax
(904) 998-7702
NPI assigned
Aug 15, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2015

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

Authorized official

Name
Crystal L Less
Title
VP of Operations
Phone
(904) 998-7000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X DN15716 FL Primary

Addresses

Primary practice location

8209 W. Beaver St.
Suite 100
Jacksonville, FL 32220

Mailing address

3545-1 St. Johns Bluff Rd. S.
Suite 352
Jacksonville, FL 32224
Phone (904) 998-7000

National Provider Directory

National Provider Directory

Locations

8209 W Beaver St
Ste 100
Jacksonville, FL 32220
Phone (904) 293-1931

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1408060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422230400000",
    "number": "1679972665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3545-1 ST. JOHNS BLUFF RD. S.",
            "address_2": "SUITE 352",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32224",
            "telephone_number": "904-998-7000",
            "fax_number": "904-998-7702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8209 W. BEAVER ST.",
            "address_2": "SUITE 100",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32220",
            "telephone_number": "904-998-7000",
            "fax_number": "904-998-7702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIETTA DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-15",
        "last_updated": "2015-01-26",
        "status": "A",
        "authorized_official_last_name": "LESS",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "904-998-7000"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN15716",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2015; 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.