NPIMap

Organization Active NPI

Myers Pediatric Dentistry PA

  • Pediatric Dentistry
  • Middleburg, FL
National Provider Identifier
1982619425
Registry record updated Aug 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
MYERS PEDIATRIC DENTISTRY PA
Practice address
3200 Old Jennings Rd
Middleburg, FL 32068-3414
Phone
(904) 505-2010
Fax
(904) 505-2011
NPI assigned
Jul 31, 2006
Last updated
Aug 17, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2010

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

Authorized official

Name
Dr. Gary Myers, DMDNPI 1639186182
Title
President
Phone
(904) 505-2010

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X NU Primary
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X NU

Addresses

Primary practice location

3200 Old Jennings Rd
Middleburg, FL 32068-3414

Mailing address

3200 Old Jennings Rd
Middleburg, FL 32068-3414
Phone (904) 505-2010

Other identifiers 2

IdentifierTypeStateIssuer
85410OtherBLUE CROSS BLUE SHIELD
1770740OtherFLUNITED CONCORDIA

National Provider Directory

National Provider Directory

Locations

3200 Old Jennings Rd
Middleburg, FL 32068
Phone (904) 505-2010

Practitioners & affiliated clinicians

Practitioners 7

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": "1154304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282003200000",
    "number": "1982619425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 OLD JENNINGS RD",
            "city": "MIDDLEBURG",
            "state": "FL",
            "postal_code": "320683414",
            "telephone_number": "904-505-2010",
            "fax_number": "904-505-2011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 OLD JENNINGS RD",
            "city": "MIDDLEBURG",
            "state": "FL",
            "postal_code": "320683414",
            "telephone_number": "904-505-2010",
            "fax_number": "904-505-2011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYERS PEDIATRIC DENTISTRY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-31",
        "last_updated": "2010-08-17",
        "status": "A",
        "authorized_official_last_name": "MYERS",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-505-2010",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "85410",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "1770740",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Middleburg, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2010; 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.