Active NPI
Robert N Mixon, D.M.D., PA
- Pediatric Dentistry
- Gainesville, FL
National Provider Identifier
1770664021
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- DN0014057
- Practice address
- 5209 SW 91St Dr
Gainesville, FL 32608-3028 - Phone
- (352) 335-7777
- Fax
- (352) 371-3430
- NPI assigned
- Oct 17, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | DN0014057 | FL | Primary |
Addresses
Primary practice location
5209 SW 91St Dr
Gainesville, FL 32608-3028
Mailing address
5209 SW 91St Dr
Gainesville, FL 32608-3028
Phone (352) 335-7777
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 071755000 | Medicaid | FL | |
| 36580 | Other | FL | BLUE CROSS BLUE SHIELD |
| 986885 | Other | FL | UNITED CONCORDIA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN0014057 | FL | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kodp PLLC | Pediatric Dentistry | Past | Accepting new patients |
| Kids Only Dental Place | Pediatric Dentistry | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Pediatric Dentistry
- Gainesville, FL
- NPI 1205067725
-
- Pediatric Dentistry
- Gainesville, FL
- NPI 1902798903
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1248998400000",
"number": "1770664021",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5209 SW 91ST DR",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "326083028",
"telephone_number": "352-335-7777",
"fax_number": "352-371-3430"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5209 SW 91ST DR",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "326083028",
"telephone_number": "352-335-7777",
"fax_number": "352-371-3430"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIXON",
"first_name": "ROBERT",
"middle_name": "N",
"credential": "D.M.D., PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-17",
"last_updated": "2009-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "FL",
"license": "DN0014057",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "071755000",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "36580",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "986885",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gainesville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.