Pediatric Smiles, Inc

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DN 15344 Issued in FL

Legal business name

PEDIATRIC SMILES, INC

Practice address

2262 Dunn Ave
Ste 4
Jacksonville, FL 32218

Phone

(904) 751-5126

Fax

(904) 751-5146

NPI assigned

Aug 24, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Staci Suggs, D.D.S.

Title

Owner/Dentist

Phone

(904) 751-5126

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1912014937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26701",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322266701",
            "telephone_number": "904-751-5126",
            "fax_number": "904-751-5146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2262 DUNN AVE",
            "address_2": "STE 4",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32218",
            "telephone_number": "904-751-5126",
            "fax_number": "904-751-5146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC SMILES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SUGGS",
        "authorized_official_first_name": "STACI",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "904-751-5126",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "FL",
            "license": "DN 15344",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADI HEALTHY KIDS",
            "identifier": "70084",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Dentistry in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Pediatric Dentistry 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.