Larry D. Burnside D.D.S.,P.a.

Primary specialty

DentistTaxonomy code 122300000X

License

7825 Issued in FL

Legal business name

LARRY D. BURNSIDE D.D.S.,P.A.

Practice address

12708 San Jose Blvd
Jacksonville, FL 32223-2689

Phone

(904) 268-0904

Fax

(904) 268-0306

NPI assigned

Nov 10, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Larry David Burnside, DDSNPI 1306917588

Title

President

Phone

(904) 268-0904

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Larry David Burnside, DDS

  • Dentist
  • Jacksonville, FL
  • NPI 1306917588
  NPD (past) Authorized official

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

{
    "created_epoch": "1163116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1861563041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 CREIGHTON RD",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320037008",
            "telephone_number": "904-264-2759",
            "fax_number": "904-268-0306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12708 SAN JOSE BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322232689",
            "telephone_number": "904-268-0904",
            "fax_number": "904-268-0306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LARRY D. BURNSIDE D.D.S.,P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BURNSIDE",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-268-0904",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "7825",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Jane Larosa, OTR/L
• Jacqueline Ann Powers Larrabaster, CABA
• Sarah Larrabee
• Samantha Larrea, MT-BC
• Larroc Dental
• Donald Lee Larsen, COTA/L, RN
• Sierra Maguire Larsen, PA-C
• Elle M Larson Whitaker
• Cassandra Leigh Larson
• Jan Marie Larson, M.D.

• Dentist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.