Crystal Clear Dental Spa LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

CRYSTAL CLEAR DENTAL SPA LLC

Practice address

7933 Baymeadows Way Ste 5
Jacksonville, FL 32256-7514

Phone

(904) 731-2162

NPI assigned

Jul 30, 2024

Organization subpart

No

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

Authorized official

Name

Jiangian Hu

Title

Owner

Phone

(904) 731-2162

Specialties & licenses 2

Addresses

Locations

Practitioners 2

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

• Bruce Arthur Kanehl, D.D.S.

  • General Practice Dentistry
  • Jacksonville, FL
  • NPI 1649401423
  NPD (past)
• Aubrie Leigh Tanner, R.D.H.

  • Dental Hygienist
  • Jacksonville, FL
  • NPI 1073866679
  NPD (past)

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

{
    "created_epoch": "1722297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722297600000",
    "number": "1750110581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7933 BAYMEADOWS WAY STE 5",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322567514",
            "telephone_number": "904-731-2162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7933 BAYMEADOWS WAY STE 5",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322567514",
            "telephone_number": "904-731-2162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL CLEAR DENTAL SPA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-30",
        "last_updated": "2024-07-30",
        "certification_date": "2024-07-30",
        "status": "A",
        "authorized_official_last_name": "HU",
        "authorized_official_first_name": "JIANGIAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-731-2162"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jaime Cruz, OTRL
• Julian Cruz
• Mya Lynn Cruz
• Tammy Cruz
• Tania Cruz, RPH
• Crystal Clear Mental Health LLC
• Crystal McFadden
• Csi Private Duty Services, Inc
• Csi-Pediatric Services, LLC
• Csi-Pediatric Services, LLC.

• Durable Medical Equipment & Medical Supplies in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Durable Medical Equipment & Medical Supplies in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2024; 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.