NPIMap

Organization Active NPI

Smiling Kidds Dentistry, P.a.

Doing business as Seaside Children's Dentistry

  • Pediatric Dentistry
  • St Augustine, FL
National Provider Identifier
1881290211
Registry record updated Mar 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
SMILING KIDDS DENTISTRY, P.A.
Doing business as
Seaside Children's Dentistry
Practice address
1100 S Ponce de Leon Blvd Ste 2
Saint Augustine, FL 32084-6013
Phone
(904) 829-6321
NPI assigned
Dec 10, 2020
Last updated
Mar 20, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2023

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

Authorized official

Name
Mr. Andrew Weaver
Title
Administrator
Phone
(904) 395-7772

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X Primary

Addresses

Primary practice location

1100 S Ponce de Leon Blvd Ste 2
Saint Augustine, FL 32084-6013

Mailing address

3020 Hartley Rd Ste 210
Jacksonville, FL 32257-8206

Other names 1

  • Seaside Children's Dentistry Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Smiling Kidds Dentistry PA8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 5

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": "1607558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679270400000",
    "number": "1881290211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3020 HARTLEY RD STE 210",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322578206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 S PONCE DE LEON BLVD STE 2",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320846013",
            "telephone_number": "904-829-6321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMILING KIDDS DENTISTRY, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-10",
        "last_updated": "2023-03-20",
        "certification_date": "2023-03-20",
        "status": "A",
        "authorized_official_last_name": "WEAVER",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "904-395-7772",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Seaside Children's Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Seaside Children's 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 Mar 20, 2023; 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.