Orange Park Dentistry

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

ORANGE PARK DENTISTRY

Practice address

784 Blanding Blvd Ste 110
Orange Park, FL 32065-7724

Phone

(904) 272-2438

NPI assigned

Dec 1, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Peter Kelly

Title

Owner

Phone

(904) 272-2438

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Practitioners 1

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

• Michael D Vanover, DDS

  • General Practice Dentistry
  • Orange Park, FL
  • NPI 1154663961
  NPD (past)

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

{
    "created_epoch": "1638316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638316800000",
    "number": "1780342352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "784 BLANDING BLVD STE 110",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320657724",
            "telephone_number": "904-272-2438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "784 BLANDING BLVD STE 110",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320657724",
            "telephone_number": "904-272-2438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORANGE PARK DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-01",
        "last_updated": "2021-12-01",
        "certification_date": "2021-12-01",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-272-2438",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "DN19430",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "DN26279",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "vanoverdentistry.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Website",
            "address_1": "784 Blanding Blvd Ste 110",
            "city": "Orange Park",
            "state": "FL",
            "country_code": "US",
            "postal_code": "320657724",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Orange Park Acute Trauma,LLC
• Orange Park Adult Day Center, LLC
• Orange Park Assisted Living Facility, Inc.
• Orange Park Audiology Clinic
• Orange Park Chiropractic Center PA
• Orange Park Endoscopy Center LLC
• Orange Park Extended Care LLC
• Orange Park Facility Operations LLC
• Orange Park FL Opco LLC
• Orange Park FL Two Opco LLC

• Dental Clinic/Center in Orange Park, FL
• Providers in Orange Park, FL by specialty
• Dental Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2021; 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.