NPIMap

Organization Active NPI

Modern Periodontics, PA

  • Dentist
  • Orange Park, FL
National Provider Identifier
1922428879
Registry record updated Apr 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN15267 Issued in FL
Legal business name
MODERN PERIODONTICS, PA
Practice address
1409 Kingsley Ave
Suite 9a
Orange Park, FL 32073-4537
Phone
(904) 278-1175
NPI assigned
Apr 18, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2014

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

Authorized official

Name
Dr. Angeline Ann Kuznia, DMD, MS
Title
Dentist/Owner
Phone
(904) 278-1175

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X DN15267 FL Primary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X DN17936 FL

Addresses

Primary practice location

1409 Kingsley Ave
Suite 9a
Orange Park, FL 32073-4537

Mailing address

1409 Kingsley Ave
Suite 9a
Orange Park, FL 32073-4537
Phone (904) 278-1175

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1397779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1397779200000",
    "number": "1922428879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1409 KINGSLEY AVE",
            "address_2": "SUITE 9A",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734537",
            "telephone_number": "904-278-1175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1409 KINGSLEY AVE",
            "address_2": "SUITE 9A",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734537",
            "telephone_number": "904-278-1175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN PERIODONTICS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-18",
        "last_updated": "2014-04-18",
        "status": "A",
        "authorized_official_last_name": "KUZNIA",
        "authorized_official_first_name": "ANGELINE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "904-278-1175",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD, MS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN15267",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN17936",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange Park, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 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.