Active NPI
Phillip Forbes, DDS
- Dentist
- St Augustine, FL
National Provider Identifier
1780200634
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN11806
- Practice address
- 405 S Ponce de Leon Blvd
St Augustine, FL 32084-4219 - Phone
- (904) 827-1881
- NPI assigned
- Jun 17, 2020
- 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 | DN11806 | FL | Primary |
Addresses
Primary practice location
405 S Ponce de Leon Blvd
St Augustine, FL 32084-4219
Mailing address
405 S Ponce de Leon Blvd
St Augustine, FL 32084-4219
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 |
|---|---|---|---|
| DN11806 | FL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1592352000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1592352000000",
"number": "1780200634",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "405 S PONCE DE LEON BLVD",
"city": "ST AUGUSTINE",
"state": "FL",
"postal_code": "320844219"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "405 S PONCE DE LEON BLVD",
"city": "ST AUGUSTINE",
"state": "FL",
"postal_code": "320844219",
"telephone_number": "904-827-1881"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORBES",
"first_name": "PHILLIP",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-06-17",
"last_updated": "2020-06-17",
"certification_date": "2020-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "DN11806",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Augustine, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 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.