Edward Lee Staudt, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN0009915 Issued in FL

Practice address

944 Bridgewater Dr
2B
Ft Orange, FL 32129

Phone

(386) 756-8953

NPI assigned

Sep 1, 2006

Sex

Male

Sole proprietor

No

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1992807960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "944 BRIDGEWATER DR",
            "address_2": "2B",
            "city": "FT ORANGE",
            "state": "FL",
            "postal_code": "32129",
            "telephone_number": "386-756-8953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "944 BRIDGEWATER DR",
            "address_2": "2B",
            "city": "FT ORANGE",
            "state": "FL",
            "postal_code": "32129",
            "telephone_number": "386-756-8953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAUDT",
        "first_name": "EDWARD",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN0009915",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.