Palm Valley Family Dentistry, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

PALM VALLEY FAMILY DENTISTRY, PLLC

Practice address

3791 Palm Valley Rd Ste 205
Ponte Vedra Beach, FL 32082-4180

Phone

(904) 834-2736

NPI assigned

Nov 21, 2024

Organization subpart

No

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

Authorized official

Name

McKenzie Worten

Title

Office Manager

Phone

(904) 834-2736

Specialties & licenses 1

Addresses

Practitioners 3

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

• Marie Cross Pucillo, D.M.D.

  • General Practice Dentistry
  • St Augustine, FL
  • NPI 1730428749
  NPD
• Lilia Joy Tabassian, DMD

  • Dentist
  • Ponte Vedra Beach, FL
  • NPI 1215683461
  NPD
• David James Yoder, DDS

  • Dentist
  • Ponte Vedra Beach, FL
  • NPI 1215257381
  NPD

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

{
    "created_epoch": "1732147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733184000000",
    "number": "1790500908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3791 PALM VALLEY RD STE 205",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320824180",
            "telephone_number": "904-834-2736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3791 PALM VALLEY RD STE 205",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320824180",
            "telephone_number": "904-834-2736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALM VALLEY FAMILY DENTISTRY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-21",
        "last_updated": "2024-12-03",
        "certification_date": "2024-12-03",
        "status": "A",
        "authorized_official_last_name": "WORTEN",
        "authorized_official_first_name": "MCKENZIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "904-834-2736"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aylin Ozdemir, M.D.
• Richard G Packo, DC
• Thomas Paganucci, M.D.
• Palm Valley Eye Care and Surgeons, LLC
• Palm Valley Family Dentistry, P.a.
• Kenneth Panganiban, PTA
• Carmen Alyssa Parker
• Kathryn Parker
• Tracie Nusca Parrish
• Manish R Patel, MP

• General Practice Dentistry in Ponte Vedra Beach, FL
• Providers in Ponte Vedra Beach, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2024; 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.