Smile So Big Flagler PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

SMILE SO BIG FLAGLER PLLC

Practice address

150 Malaga St
St Augustine, FL 32084-3521

Phone

(904) 829-9024

NPI assigned

Oct 17, 2024

Organization subpart

No

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

Authorized official

Name

Jonathan Aalona Montoya, DDS

Title

Owner

Phone

(904) 829-9024

Specialties & licenses 1

Addresses

Other names 2

• Michael Versaggi DDS Former legal business name
• Versaggi Dental Former legal business name

Locations

Practitioners 3

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

• Marie Cross Pucillo, D.M.D.

  • General Practice Dentistry
  • St Augustine, FL
  • NPI 1730428749
  NPD
• Alex Joseph Liboon Rustia, DMD

  • General Practice Dentistry
  • St Augustine, FL
  • NPI 1194554535
  NPD (past)
• Michael Andrew Versaggi, DDS

  • Dentist
  • St Augustine, FL
  • NPI 1972789725
  NPD (past)

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

{
    "created_epoch": "1729123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729123200000",
    "number": "1942021514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 MALAGA ST",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320843521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 MALAGA ST",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320843521",
            "telephone_number": "904-829-9024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMILE SO BIG FLAGLER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-17",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A",
        "authorized_official_last_name": "MONTOYA",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "AALONA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-829-9024",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Michael Versaggi DDS",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Versaggi Dental",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Small Talk Inc
• Sydni Small
• Carolyn Hunter Smallwood
• Christina SW Smethie, OTRL CHT
• Smile So Big First City LLC
• Smiling Kidds Dentistry, P.a.
• Irving Hadden Smith III III, RRT
• Amy Smith
• Bethany Smith
• Candace Smith, ARNP

• Dental Clinic/Center in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Dental Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2024; 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.