Bean Sprout Inc

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

17658 Issued in FL

Legal business name

BEAN SPROUT INC

Doing business as

Bean Tree Pediatric Dentistry

Practice address

2008 Riverside Ave
Suite 101
Jacksonville, FL 32204-4443

Phone

(904) 372-3260

Fax

(904) 385-3704

NPI assigned

Jan 8, 2015

Last updated

Jan 8, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jodi Mason, DMDNPI 1932317922

Title

Pediatric Dentist

Phone

(904) 372-3260

Specialties & licenses 1

Addresses

Other names 1

• Bean Tree Pediatric Dentistry Doing business as

Locations

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.

• Jodi Eve Mason, DMD

  • Pediatric Dentistry
  • Jacksonville, FL
  • NPI 1932317922
  NPD Authorized official

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

{
    "created_epoch": "1420675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1420675200000",
    "number": "1942698204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2008 RIVERSIDE AVE",
            "address_2": "SUITE 101",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044443",
            "telephone_number": "904-372-3260",
            "fax_number": "904-385-3704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2008 RIVERSIDE AVE",
            "address_2": "SUITE 101",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044443",
            "telephone_number": "904-372-3260",
            "fax_number": "904-385-3704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAN SPROUT INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-08",
        "last_updated": "2015-01-08",
        "status": "A",
        "authorized_official_last_name": "MASON",
        "authorized_official_first_name": "JODI",
        "authorized_official_title_or_position": "PEDIATRIC DENTIST",
        "authorized_official_telephone_number": "904-372-3260",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "FL",
            "license": "17658",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bean Tree Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Irmatine S Bealyer, RD
• Joel Beam, EDD, LAT, ATC
• Roderick T Beaman Jr., D.O.
• Sarah Anne Beaman, ATR-BC
• Kristy Lee Beams, PMHNP
• Rhea Bean-Bates, DPT
• Bradley Bean, DO
• Heather Marie Bean, ARNP
• Justin Bean
• Monte Beane

• Dental Clinic/Center in Jacksonville, FL
• Providers in Jacksonville, 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 Jan 8, 2015; 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.