Surfside Dental Center, PA.

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

DN15716 Issued in FL

Legal business name

SURFSIDE DENTAL CENTER, PA.

Practice address

630-7 Atlantic Blvd.
Neptune Beach, FL 32266

Phone

(904) 247-2626

Fax

(904) 247-2291

NPI assigned

Aug 27, 2013

Organization subpart

No

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 2

Addresses

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

{
    "created_epoch": "1377561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421971200000",
    "number": "1740614775",
    "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": "630-7 ATLANTIC BLVD.",
            "city": "NEPTUNE BEACH",
            "state": "FL",
            "postal_code": "32266",
            "telephone_number": "904-247-2626",
            "fax_number": "904-247-2291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURFSIDE DENTAL CENTER, PA.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-27",
        "last_updated": "2015-01-23",
        "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": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "FL",
            "license": "DN15716",
            "primary": true
        },
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "FL",
            "license": "DN15716",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan E. Stewart, LAC
• Nicole Pollock Story, ED.S, LMHC, LMFT
• Strategies for Social Success, LLC
• Stuart Young, PH.D. Associates P.a.
• Suncoast Labs, LLC
• Surfside Dental Specialist
• Susan M. Morrison LMHC PA
• Tanner Medical Enterprises, Inc
• Blaire Taylor
• Laura Michelle Taylor, PHARMD

• Preferred Provider Organization in Neptune Beach, FL
• Providers in Neptune Beach, FL by specialty
• Preferred Provider Organization in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 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.