Gulfshore Pediatric Dentistry, P.a.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DN17564 Issued in FL

Legal business name

GULFSHORE PEDIATRIC DENTISTRY, P.A.

Practice address

9921 Corkscrew Rd
Estero, FL 33928

Phone

(239) 776-2115

NPI assigned

May 18, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Tia Shea Sammons, DMD

Title

Pediatric Dentist

Phone

(239) 776-2115

Specialties & licenses 2

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1431907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431907200000",
    "number": "1982082335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9921 CORKSCREW RD",
            "city": "ESTERO",
            "state": "FL",
            "postal_code": "33928",
            "telephone_number": "239-776-2115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9921 CORKSCREW RD",
            "city": "ESTERO",
            "state": "FL",
            "postal_code": "33928",
            "telephone_number": "239-776-2115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GULFSHORE PEDIATRIC DENTISTRY, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-18",
        "last_updated": "2015-05-18",
        "status": "A",
        "authorized_official_last_name": "SAMMONS",
        "authorized_official_first_name": "TIA",
        "authorized_official_middle_name": "SHEA",
        "authorized_official_title_or_position": "PEDIATRIC DENTIST",
        "authorized_official_telephone_number": "239-776-2115",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "FL",
            "license": "DN17564",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "FL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002138100",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "076870700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Edward Eugene Grubbs Jr., BC-HIS
• Joanna Gualtieri, LMHC
• Gulf Coast Brain and Spine Center
• Gulf Coast Medical Associates LLC
• Gulfcoast Foot and Ankle Specialists LLC
• Christina M Gunger, MPT
• Katherine Gutierrez, LMHC
• H&H Neyra LLC
• Alesandra Taiwo Haastrup
• Whitney Haidet, DMD

• Pediatric Dentistry in Estero, FL
• Providers in Estero, FL by specialty
• Pediatric Dentistry in Florida

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