Ailleen Acosta Gonzalez, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DN25909 Issued in FL

Practice address

4520 Town Center Pway
#103
Jacksonville, FL 32246

Phone

(904) 580-7861

NPI assigned

Jun 11, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jacksonville Florida North, PLLC

  • General Practice Dentistry
  • Jacksonville, FL
  • NPI 1982414066
  NPD (past)

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

{
    "created_epoch": "1623369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628812800000",
    "number": "1720656275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12151 SILVER SADDLE DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322581212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4520 TOWN CENTER PWAY",
            "address_2": "#103",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32246",
            "telephone_number": "904-580-7861"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12151 Silver Saddle Dr",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322581212",
            "country_code": "US",
            "telephone_number": "502-905-4226",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ACOSTA GONZALEZ",
        "first_name": "AILLEEN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-11",
        "last_updated": "2021-08-13",
        "certification_date": "2021-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN25909",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel James Ackerson, M.D.
• Acknowledge U Counseling & Consulting Services
• Shanell Ackron
• Acma Medical Transports LLC
• Acn Baromedical Center
• Manuel Alejandro Acosta Hernandez, DDS
• Luis Enrique Acosta Rizo
• Janette Felisa Acosta Sanz, APRN
• Maria Victoria Acosta-Rua, M.D.
• Craig J Acosta, PA-C

• Dentist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 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.