NPIMap

Organization Active NPI

Edward L. Staudt DDS & Kenneth L. Staudt DDS, MPH

  • General Practice Dentistry
  • Port Orange, FL
National Provider Identifier
1912321654
Registry record updated Feb 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN11886 Issued in FL
Legal business name
EDWARD L. STAUDT DDS & KENNETH L. STAUDT DDS, MPH
Practice address
944 Bridgewater Dr.
Suite 2-B
Port Orange, FL 32129
Phone
(386) 756-8953
NPI assigned
Feb 18, 2014
Last updated
Feb 20, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
EDWARD L. STAUDT DDS & KENNETH L. STAUDT DDS, MPHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 20, 2014

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

Authorized official

Name
Dr. Kenneth Lee Staudt Jr., DDS, MPHNPI 1225258270
Title
Dentist
Phone
(386) 214-7554

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X DN11886 FL Primary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X DN9915 FL

Addresses

Primary practice location

944 Bridgewater Dr.
Suite 2-B
Port Orange, FL 32129

Mailing address

944 Bridgewater Dr.
Suite 2-B
Port Orange, FL 32129
Phone (386) 756-8953

National Provider Directory

National Provider Directory
Part of
Edward L Staudt DDS Kenneth L Staudt DDS MPH

Practitioners & affiliated clinicians

Practitioners 1

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": "1392681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1392854400000",
    "number": "1912321654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "944 BRIDGEWATER DR.",
            "address_2": "SUITE 2-B",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "32129",
            "telephone_number": "386-756-8953",
            "fax_number": "386-756-9184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "944 BRIDGEWATER DR.",
            "address_2": "SUITE 2-B",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "32129",
            "telephone_number": "386-756-8953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDWARD L. STAUDT DDS & KENNETH L. STAUDT DDS, MPH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EDWARD L. STAUDT DDS & KENNETH L. STAUDT DDS, MPH",
        "enumeration_date": "2014-02-18",
        "last_updated": "2014-02-20",
        "status": "A",
        "authorized_official_last_name": "STAUDT",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "386-214-7554",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DDS, MPH"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN11886",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN9915",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Orange, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2014; 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.