NPIMap

Organization Active NPI

Professional Dental Alliance of Jacksonville Ozark, PLLC

  • General Practice Dentistry
  • Jacksonville, FL
National Provider Identifier
1861042541
Registry record updated Sep 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
PROFESSIONAL DENTAL ALLIANCE OF JACKSONVILLE OZARK, PLLC
Practice address
7768 Ozark Dr Ste 200
Jacksonville, FL 32256-5839
Phone
(904) 442-6000
NPI assigned
Sep 16, 2019
Last updated
Sep 16, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2019

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

Authorized official

Name
Lauren Howard, MA
Title
Credentialing Specialist
Phone
(757) 576-5479

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

7768 Ozark Dr Ste 200
Jacksonville, FL 32256-5839

Mailing address

11 S Mill St Ste 200
New Castle, PA 16101-3680

National Provider Directory

National Provider Directory

Locations

7768 Ozark Dr
Ste 200
Jacksonville, FL 32256
Phone (904) 442-6000

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1568592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568592000000",
    "number": "1861042541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 S MILL ST STE 200",
            "city": "NEW CASTLE",
            "state": "PA",
            "postal_code": "161013680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7768 OZARK DR STE 200",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322565839",
            "telephone_number": "904-442-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL DENTAL ALLIANCE OF JACKSONVILLE OZARK, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-16",
        "last_updated": "2019-09-16",
        "status": "A",
        "authorized_official_last_name": "HOWARD",
        "authorized_official_first_name": "LAUREN",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "757-576-5479",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2019; 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.