Professional Dental Alliance of Fernandina Beach, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

PROFESSIONAL DENTAL ALLIANCE OF FERNANDINA BEACH, PLLC

Practice address

2896 S 8TH St
Fernandina, FL 32034-4462

Phone

(904) 261-6826

NPI assigned

Jan 16, 2020

Organization subpart

No

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

Authorized official

Name

Lauren Howard

Title

Credentialing Specialist

Phone

(757) 576-5479

Specialties & licenses 1

Addresses

Practitioners 2

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

• Lauren Tomlinson, DMD

  • Dentist
  • Fernandina Beach, FL
  • NPI 1306499561
  NPD
• Robert Harris Friedman, D.M.D.

  • Dentist
  • Callahan, FL
  • NPI 1003819657

  General Practice

  NPD (past)

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

{
    "created_epoch": "1579132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579132800000",
    "number": "1740810951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 S MILL ST STE 200",
            "city": "NEW CASTLE",
            "state": "PA",
            "postal_code": "161013680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2896 S 8TH ST",
            "city": "FERNANDINA",
            "state": "FL",
            "postal_code": "320344462",
            "telephone_number": "904-261-6826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL DENTAL ALLIANCE OF FERNANDINA BEACH, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-16",
        "last_updated": "2020-01-16",
        "certification_date": "2020-01-16",
        "status": "A",
        "authorized_official_last_name": "HOWARD",
        "authorized_official_first_name": "LAUREN",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "757-576-5479"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Latoya Tunise Kuester, M.D.
• Brenda L Lee
• Shauna McNabb
• Nutrition Ignition LLC
• Jeffrey Elliot Packer, M.D.
• Tia Briana Raysor, PHARMD
• Russell Stackhouse MD PA (Coastal Vision Center)
• Robert Harvey Springer III, P.T.A.
• James Russell Keller Stackhouse, MD
• Taylor John Vissers

• General Practice Dentistry in Fernandina, FL
• Providers in Fernandina, 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 Jan 16, 2020; 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.