NPIMap

Organization Active NPI

Islands Edge Dental, LLC

Doing business as Island's Edge Family Dentistry

  • Dental Clinic/Center
  • St Augustine, FL
National Provider Identifier
1861162141
Registry record updated Sep 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
ISLANDS EDGE DENTAL, LLC
Doing business as
Island's Edge Family Dentistry
Practice address
1301 Plantation Island Dr S Ste 104B
St Augustine, FL 32080-3110
Phone
(904) 461-5566
Fax
(904) 461-0084
NPI assigned
Sep 17, 2021
Last updated
Sep 17, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2021

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

Authorized official

Name
Dr. Andrew Mullet, DDSNPI 1417399171
Title
General Dentist
Phone
(904) 461-5566

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X NU Primary

Addresses

Primary practice location

1301 Plantation Island Dr S Ste 104B
St Augustine, FL 32080-3110

Mailing address

1301 Plantation Island Dr S Ste 104B
St Augustine, FL 32080-3110
Phone (904) 461-5566

Other names 1

  • Island's Edge Family Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

1301 Plantation Island Dr S
Ste 104B
Saint Augustine, FL 32080
Phone (904) 461-5566

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1631836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631836800000",
    "number": "1861162141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 PLANTATION ISLAND DR S STE 104B",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320803110",
            "telephone_number": "904-461-5566",
            "fax_number": "904-461-0084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 PLANTATION ISLAND DR S STE 104B",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320803110",
            "telephone_number": "904-461-5566",
            "fax_number": "904-461-0084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISLANDS EDGE DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-17",
        "last_updated": "2021-09-17",
        "certification_date": "2021-09-17",
        "status": "A",
        "authorized_official_last_name": "MULLET",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "GENERAL DENTIST",
        "authorized_official_telephone_number": "904-461-5566",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Island's Edge Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Augustine, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 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.