Ponce de Leon Family Dentistry

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

PONCE DE LEON FAMILY DENTISTRY

Practice address

4 Saint Johns Medical PK Dr
Saint Augustine, FL 32086-5298

Phone

(904) 797-9009

Fax

(904) 797-9057

NPI assigned

Jul 3, 2008

Last updated

Jul 3, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Theodore Daniel HaeussnerNPI 1033270715

Title

Dentist

Phone

(904) 797-8247

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Theodore Daniel Haeussner, D.M.D.

  • Dentist
  • St Augustine, FL
  • NPI 1033270715
  NPD (past) Authorized official

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

{
    "created_epoch": "1215043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215043200000",
    "number": "1801059480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 SAINT JOHNS MEDICAL PK DR",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320865298",
            "telephone_number": "904-797-9009",
            "fax_number": "904-797-9057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 SAINT JOHNS MEDICAL PK DR",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320865298",
            "telephone_number": "904-797-9009",
            "fax_number": "904-797-9057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PONCE DE LEON FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-03",
        "last_updated": "2008-07-03",
        "status": "A",
        "authorized_official_last_name": "HAEUSSNER",
        "authorized_official_first_name": "THEODORE",
        "authorized_official_middle_name": "DANIEL",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "904-797-8247",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Podiatry Associates of Florida Inc
• Jency Nahomy Polanco, APRN
• Polished Dental Professionals, PLLC
• Maressa T Pollen
• Jennie Angela Poma-Jones, LCSW
• Ponce Home Medical Equipment Inc
• Ponce Home Medical Equipment, Inc.
• Ponce NH LLC
• Louis John Pontarelli
• Nitesh Popat, DDS

• Dental Clinic/Center in St Augustine, FL
• Providers in St Augustine, 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 Jul 3, 2008; 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.