Active NPI
Andrew Bellebaum, DMD
- Dentist
- Jacksonville, FL
National Provider Identifier
1780098723
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 8380
- Practice address
- 554 Keily Street Bureau of Med and Sur
Centralized Credentials and Privilegeing
Jacksonville, FL 32312 - Phone
- (757) 953-8609
- NPI assigned
- Jun 18, 2014
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 8380 | SC | Primary |
Addresses
Primary practice location
554 Keily Street Bureau of Med and Sur
Centralized Credentials and Privilegeing
Jacksonville, FL 32312
Mailing address
554 Keily Street Bureau of Med and Sur
Centralized Credentials and Privi Privilegeing
Jacksonville, FL 32312
Phone (757) 953-8609
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8380 | SC | MD | School Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Carolina Park Family Dentistry LLC | Dentist | Current | Accepting new patients |
Organizations & group practices 1
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.
-
- Dentist
- Mount Pleasant, SC
- NPI 1851906028
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1403049600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1403049600000",
"number": "1780098723",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "554 KEILY STREET BUREAU OF MED AND SUR",
"address_2": "CENTRALIZED CREDENTIALS AND PRIVI PRIVILEGEING",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "32312",
"telephone_number": "757-953-8609"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "554 KEILY STREET BUREAU OF MED AND SUR",
"address_2": "CENTRALIZED CREDENTIALS AND PRIVILEGEING",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "32312",
"telephone_number": "757-953-8609"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BELLEBAUM",
"first_name": "ANDREW",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-06-18",
"last_updated": "2014-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "SC",
"license": "8380",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.