NPIMap

Organization Active NPI

St. Johns River Dental

  • General Practice Dentistry
  • Palatka, FL
National Provider Identifier
1790024248
Registry record updated Feb 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
ST. JOHNS RIVER DENTAL
Practice address
500 S Highway 19
Palatka, FL 32177-3943
Phone
(386) 325-5467
Fax
(386) 325-2635
NPI assigned
Feb 4, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2013

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

Authorized official

Name
Dr. Derek Ray Morris, D.D.S., P.C.NPI 1487851416
Title
Owner
Phone
(386) 325-5467

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

500 S Highway 19
Palatka, FL 32177-3943

Mailing address

500 S Highway 19
Palatka, FL 32177-3943
Phone (386) 325-5467

National Provider Directory

National Provider Directory

Locations

500 S Highway 19
Palatka, FL 32177
Phone (386) 325-5467

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1359936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359936000000",
    "number": "1790024248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 S HIGHWAY 19",
            "city": "PALATKA",
            "state": "FL",
            "postal_code": "321773943",
            "telephone_number": "386-325-5467",
            "fax_number": "386-325-2635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 S HIGHWAY 19",
            "city": "PALATKA",
            "state": "FL",
            "postal_code": "321773943",
            "telephone_number": "386-325-5467",
            "fax_number": "386-325-2635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOHNS RIVER DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-04",
        "last_updated": "2013-02-04",
        "status": "A",
        "authorized_official_last_name": "MORRIS",
        "authorized_official_first_name": "DEREK",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "386-325-5467",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S., P.C."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palatka, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2013; 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.