Marie Cross Pucillo, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN22667 Issued in FL

Practice address

150 Malaga St
St Augustine, FL 32084-3521

Phone

(904) 829-9024

Fax

(904) 829-3546

NPI assigned

Feb 11, 2013

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Dr. Marie Elizabeth Cross Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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

• Palm Valley Family Dentistry, PLLC

  • General Practice Dentistry
  • Ponte Vedra Beach, FL
  • NPI 1790500908
  NPD
• Smile So Big Flagler PLLC

  • Dental Clinic/Center
  • St Augustine, FL
  • NPI 1942021514
  NPD

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

{
    "created_epoch": "1360540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1730428749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 MALAGA ST",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320843521",
            "telephone_number": "904-829-9024",
            "fax_number": "904-829-3546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 MALAGA ST",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320843521",
            "telephone_number": "904-829-9024",
            "fax_number": "904-829-3546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUCILLO",
        "first_name": "MARIE",
        "middle_name": "CROSS",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-02-11",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN22667",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARIE",
            "last_name": "CROSS",
            "middle_name": "ELIZABETH",
            "prefix": "DR.",
            "credential": "D.M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• General Practice Dentistry in St Augustine, FL
• Providers in St Augustine, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.