NPIMap

Organization Active NPI

Jacksonville Emergency Dental North, PLLC

  • General Practice Dentistry
  • Jacksonville, FL
National Provider Identifier
1962147686
Registry record updated Apr 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
JACKSONVILLE EMERGENCY DENTAL NORTH, PLLC
Practice address
1840 Dunn Ave Ste 3
Jacksonville, FL 32218-4785
Phone
(904) 224-0046
NPI assigned
Apr 28, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2022

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

Authorized official

Name
Michael James Thomasino, DMDNPI 1699924365
Title
Owner
Phone
(904) 891-6691

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

1840 Dunn Ave Ste 3
Jacksonville, FL 32218-4785

Mailing address

789 Mill Stream Rd
Ponte Vedra Beach, FL 32082-4148
Phone (904) 891-6691

Other names 1

  • Jacksonville Emergency and Family Dental Care Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address info@904dentist.com Direct

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1651104000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651104000000",
    "number": "1962147686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "789 MILL STREAM RD",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320824148",
            "telephone_number": "904-891-6691",
            "fax_number": "904-263-4560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1840 DUNN AVE STE 3",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322184785",
            "telephone_number": "904-224-0046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSONVILLE EMERGENCY DENTAL NORTH, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-28",
        "last_updated": "2022-04-28",
        "certification_date": "2022-04-28",
        "status": "A",
        "authorized_official_last_name": "THOMASINO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-891-6691",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@904dentist.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1840 Dunn Ave Ste 3",
            "city": "Jacksonville",
            "state": "FL",
            "country_code": "US",
            "postal_code": "322184785",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Jacksonville Emergency and Family Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2022; 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.