MEDICAID DENTISTRY OF DAYTONA LLC (NPI# 1326470436) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326470436 |
| Entity Type | Organization |
| Organization Name | MEDICAID DENTISTRY OF DAYTONA LLC |
| Other Organization Name | DAYTONA PEDIATRIC DENTISTRY |
| Practice Address |
1021 South Ridgewood Ave Daytona Beach FL 32114 |
| Practice Telephone | 3863042677 |
| Practice Fax Number | 3863041899 |
| Mailing Telephone | 3863042677 |
| Mailing Fax Number | 3863041899 |
| Enumeration Date | 2013-07-31 |
| Last Update Date | 2018-05-21 |
| Authorized Official Name | MR. MUBASHIR CHAUDHRY (OWNER) |
| Authorized Official Telephone | 3863042677 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 122300000X | Dentist | FL | Dental Providers | |
| N | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
DN18742 | FL | Dental Providers |
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
DN13783 | FL | Dental Providers |
| Other Name | Type Code |
|---|---|
| Daytona Pediatric Dentistry | Other Name - Individual/Organization |
| Street Address |
1021 SOUTH RIDGEWOOD AVE |
| City | DAYTONA BEACH |
| State | FL |
| Zip Code | 32114 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376161380 | Evolution Health & Performance LLC | Physician Assistant | 244 S. Palmetto Ave, Daytona Beach, FL 32114 | 2020-07-07 |
| 1407480189 | Kierra Imani Kinsey | Behavior Technician | 1128-a Beville Rd, Daytona Beach, FL 32114 | 2020-03-02 |
| 1043776057 | Outreach Community Care Network Inc | Pharmacy | 240 N. Frederick Avenue, Daytona Beach, FL 32114 | 2019-02-14 |
| 1033681861 | Katherine Proppe | Specialist/Technologist | 1 Aerospace Blvd, Daytona Beach, FL 32114 | 2018-12-18 |
| 1841765047 | Anna L Smith | Nurse Practitioner | 339 Bill France Blvd Ste C, Daytona Beach, FL 32114 | 2018-10-04 |
| 1154806933 | Steve Anthony Lee | Family Medicine | 731 N. Clyde Morris Blvd, Daytona Beach, FL 32114 | 2018-09-27 |
| 1285116491 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 1348 W International Speedway Blvd Ste 2, Daytona Beach, FL 32114 | 2018-09-04 |
| 1770085656 | Merina Lee | Occupational Therapist | 1159 Australia Ave., Daytona Beach, FL 32114 | 2018-03-06 |
| 1346752755 | Hand & Upper Extremity Surgery of Daytona Beach, LLC | Non-Pharmacy Dispensing Site | 1241 Ridgewood Ave, Daytona Beach, FL 32114 | 2017-10-26 |
| 1104347053 | Harry Herman Blanke IIi | Family Medicine | 201 N Clyde Morris Blvd, Suite 200, Halifax Health Family Medicine Residency Program, Daytona Beach, FL 32114 | 2017-06-30 |
| Find all providers in zip 32114 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063649580 | Falastin R. Abu-samn | Dentist | 2570 S Atlantic Ave, Daytona Beach, FL 32118-5523 | 2009-06-11 |
| 1073613600 | Charles Robert Brown | Dentist | 912 S Ridgewood Ave, Suite B, Daytona Beach, FL 32114-5349 | 2006-09-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073113296 | Pediatric Dental Center of Gardens Inc | Dentist | 18244 Nw 27th Ave, Miami Gardens, FL 33056-3501 | 2020-10-27 |
| 1205446598 | Harp Pediatric Dentistry | Dentist | 31067 Us Highway 19 N, Palm Harbor, FL 34684-4416 | 2020-08-03 |
| 1043829377 | Little Champions Pediatric Dentistry | Dentist | 1330 Sw 22nd St Ste 406, Miami, FL 33145-2945 | 2020-07-22 |
| 1710595509 | Bright Smiles Pediatric Dentistry Nassau LLC | Dentist | 960135 Gateway Blvd, Fernandina Beach, FL 32034-9120 | 2020-07-17 |
| 1578180097 | Juliana Grace Fitzgerald | Dentist | 7505 Grand Lely Dr Bldg 1, Naples, FL 34113-1753 | 2020-06-30 |
| 1861012569 | Toni-marie Small | Dentist | 12625 76th Rd N, West Palm Beach, FL 33412-2259 | 2020-04-22 |
| 1003446824 | Spring Hill Pediatric Dentistry, LLC | Dentist | 7140 Sagheer St., Brooksville, FL 34613 | 2020-01-21 |
| 1114573086 | Kids Dentist LLC | Dentist | 8058 W Mcnab Rd, North Lauderdale, FL 33068-4254 | 2019-08-15 |
| 1558915157 | Dentistry for Children of Florida, Pllc | Dentist | 3021 Airport Rd N Ste 203, Naples, FL 34105-3077 | 2019-07-31 |
| 1528620937 | Catherine Jane Graham | Dentist | 1395 Center Dr Rm D11-6, Gainesville, FL 32610-3006 | 2019-07-05 |
| Find all providers with the same taxonomy | ||||
| City | DAYTONA BEACH |
| Zip Code | 32114 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.