Primary Dental Group LLC

Primary specialty

DentistTaxonomy code 122300000X

License

DN15749 Issued in FL

Legal business name

PRIMARY DENTAL GROUP LLC

Practice address

1845 Eastwest Pkwy
Suite 3 & 4
Fleming Island, FL 32003-6405

Phone

(904) 278-7308

Fax

(904) 264-0086

NPI assigned

Jan 25, 2016

Last updated

Jan 25, 2016By 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

Stephen Strout, DMD

Title

Owner

Phone

(904) 806-2037

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1453680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453680000000",
    "number": "1841657640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1845 EASTWEST PKWY",
            "address_2": "SUITE 3 & 4",
            "city": "FLEMING ISLAND",
            "state": "FL",
            "postal_code": "320036405",
            "telephone_number": "904-278-7308",
            "fax_number": "904-264-0086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1845 EASTWEST PKWY",
            "address_2": "SUITE 3 & 4",
            "city": "FLEMING ISLAND",
            "state": "FL",
            "postal_code": "320036405",
            "telephone_number": "904-278-7308",
            "fax_number": "904-264-0086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY DENTAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-25",
        "last_updated": "2016-01-25",
        "status": "A",
        "authorized_official_last_name": "STROUT",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-806-2037",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN15749",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2016; 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.