Jacksonville Tongue Tie LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

JACKSONVILLE TONGUE TIE LLC

Practice address

196 Everest LN Ste 1
Saint Johns, FL 32259-4103

Phone

(904) 584-9004

NPI assigned

Dec 15, 2021

Organization subpart

No

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

Authorized official

Name

Stacey Veal

Title

Practice Administrator

Phone

(904) 584-9004

Specialties & licenses 1

Addresses

Locations

Practitioners 3

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.

• Matthew Bright, D.M.D.

  • Pediatric Dentistry
  • Saint Johns, FL
  • NPI 1356755474
  NPD (past)
• Natalia Maria Caballero Marrero, DDS

  • Pediatric Dentistry
  • Saint Johns, FL
  • NPI 1932661683
  NPD (past)
• Daniel Kuruvilla

  • Pediatric Dentistry
  • Yulee, FL
  • NPI 1902482003
  NPD (past)

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

{
    "created_epoch": "1639526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639526400000",
    "number": "1831858067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "196 EVEREST LN STE 1",
            "city": "SAINT JOHNS",
            "state": "FL",
            "postal_code": "322594103",
            "telephone_number": "904-584-9004",
            "fax_number": "904-347-2011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "196 EVEREST LN STE 1",
            "city": "SAINT JOHNS",
            "state": "FL",
            "postal_code": "322594103",
            "telephone_number": "904-584-9004"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "463725 State Road 200 Ste 3",
            "address_purpose": "LOCATION",
            "city": "Yulee",
            "state": "FL",
            "postal_code": "320978671",
            "country_code": "US",
            "telephone_number": "904-849-2400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "JACKSONVILLE TONGUE TIE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-15",
        "last_updated": "2021-12-15",
        "certification_date": "2021-12-15",
        "status": "A",
        "authorized_official_last_name": "VEAL",
        "authorized_official_first_name": "STACEY",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "904-584-9004"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexandra Jabornik Jackson
• Marika Lauren Collymore Jackson, DPM
• Jacksonville Ambulatory Surgery Center, LLC
• Jacksonville Center for Sexual Health, LLC
• Jacksonville Dental and Medical Temp Agency (jax dental and medical)
• Leigh Ann Jacob, RCSWI
• Jaes, PLLC
• Ireland Shae Jarvis, PT, DPT
• Jax Audiology & Hearing Aid Center, Inc.
• JC Family Dentistry PA

• Pediatric Dentistry in Saint Johns, FL
• Providers in Saint Johns, FL by specialty
• Pediatric Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 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.