NPIMap

Organization Active NPI

Periodontal Specialists of North Florida

Doing business as Modern Periodontics

  • Dentist
  • Orange Park, FL
National Provider Identifier
1982092326
Registry record updated Jan 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN15267 Issued in FL
Legal business name
PERIODONTAL SPECIALISTS OF NORTH FLORIDA
Doing business as
Modern Periodontics
Practice address
1409 Kingsley Ave
Suite 9a
Orange Park, FL 32073-4537
Phone
(904) 278-1175
Fax
(904) 278-1176
NPI assigned
Jan 8, 2015
Last updated
Jan 8, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2015

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

Authorized official

Name
Dr. Angeline A Kuznia, D.M.D, M.S.NPI 1710915335
Title
Owner
Phone
(904) 278-1175

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DN17936 FL
Dentist 122300000X DN15267 FL Primary

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

Other names 1

  • Modern Periodontics Doing business as

National Provider Directory

National Provider Directory

Locations

1409 Kingsley Ave
Ste 9A
Orange Park, FL 32073
Phone (904) 278-1175

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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": "1982092326",
    "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",
            "fax_number": "904-278-1176"
        },
        {
            "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",
            "fax_number": "904-278-1176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERIODONTAL SPECIALISTS OF NORTH FLORIDA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-08",
        "last_updated": "2015-01-08",
        "status": "A",
        "authorized_official_last_name": "KUZNIA",
        "authorized_official_first_name": "ANGELINE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-278-1175",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D, M.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN17936",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN15267",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Modern Periodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 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.