JACKSONVILLE DENTAL SPECIALISTS (NPI# 1568915387) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568915387 |
| Entity Type | Organization |
| Organization Name | JACKSONVILLE DENTAL SPECIALISTS |
| Practice Address |
11512 Lake Mead Ave Ste. 532 Jacksonville FL 32256-9680 |
| Practice Telephone | 9044604201 |
| Practice Fax Number | 9046833914 |
| Mailing Telephone | 9044604201 |
| Mailing Fax Number | 9046833914 |
| Enumeration Date | 2016-07-28 |
| Last Update Date | 2016-07-28 |
| Authorized Official Name | LYDIA CUEVAS (PRACTICE COORDINATOR) |
| Authorized Official Telephone | 9046834781 |
| Is Organization Subpart | Y |
| Parent Organization Name | JACKSONVILLE DENTAL SPECIALISTS |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223P0300X |
Dentist Specialization: Periodontics |
DN16648 | FL | Dental Providers |
| Y | 1223P0700X |
Dentist Specialization: Prosthodontics |
DN18280 | FL | Dental Providers |
| Street Address |
11512 LAKE MEAD AVE STE. 532 |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32256-9680 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205831906 | Jerome O Sugar | Otolaryngology | 11512 Lake Mead Ave, Ste 531, Jacksonville, FL 32256-9680 | 2005-06-17 |
| 1952949166 | Savannah Moore | Speech-Language Pathologist | 11512 Lake Mead Ave, Jacksonville, FL 32256-9680 | 2019-12-18 |
| 1225594427 | Celena Allen | Nurse Practitioner | 11512 Lake Mead Ave, Jacksonville, FL 32256-9680 | 2019-02-13 |
| 1306300017 | Tara Elizabeth Strange | Speech-Language Pathologist | 11512 Lake Mead Ave, Jacksonville, FL 32256-9680 | 2019-01-27 |
| 1457826810 | Annette Marie Tharp-wright | Counselor | 11512 Lake Mead Ave, Jacksonville, FL 32256-9680 | 2018-10-11 |
| 1023515418 | Samantha J Barry | Nurse Practitioner | 11512 Lake Mead Ave, Jacksonville, FL 32256-9680 | 2018-04-11 |
| 1073068235 | Juliann Abecassis | Acupuncturist | 11512 Lake Mead Ave, Suite 605, Jacksonville, FL 32256-9680 | 2016-08-17 |
| 1972957272 | Kayla Raulerson | Behavioral Analyst | 11512 Lake Mead Ave, Suite 601, Jacksonville, FL 32256-9680 | 2016-04-22 |
| 1710331830 | Anna Beth Baden | Behavioral Analyst | 11512 Lake Mead Ave, Suite 601, Jacksonville, FL 32256-9680 | 2016-04-14 |
| 1699138289 | Amanda Coad | Behavioral Analyst | 11512 Lake Mead Ave, Suite 601, Jacksonville, FL 32256-9680 | 2016-03-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841890464 | Alice Sanchez | Dietitian, Registered | 7643 Gate Parkway, Suite 104-1128, Jacksonville, FL 32256 | 2020-11-01 |
| 1093327702 | Oaktree Dental LLC | Clinic/Center | 14595 Philips Highway, Jacksonville, FL 32256 | 2020-08-24 |
| 1538787866 | Tywanna Council | Massage Therapist | 4720 Salisbury Road #102, Jacksonville, FL 32256 | 2020-07-13 |
| 1275155368 | Christy Orellana | Social Worker | 5011 Gate Parkway Bldg 100 Suite 100, Jacksonville, FL 32256 | 2020-05-11 |
| 1376175117 | Diane Stover | Case Manager/Care Coordinator | 7001 A. C. Skinner Parkway, Jacksonville, FL 32256 | 2020-02-10 |
| 1982235859 | Sandra Josefina Baez Nunez | Nurse Practitioner | 10739 Deerwood Park Blvd, Suite 200, Jacksonville, FL 32256 | 2020-01-30 |
| 1205476496 | Point Meadows Dental Center, Inc. | Dentist | 10915 Baymeadows Rd, #106, Jacksonville, FL 32256 | 2020-01-15 |
| 1598324113 | Dhaval Yogeshkumar Shah | Dentist | 8206 Philips Hwy., Suite 21, Jacksonville, FL 32256 | 2019-06-07 |
| 1003472499 | Dade Medical, Inc. | Durable Medical Equipment & Medical Supplies | 9143 Philips Highway Suite 270, Jacksonville, FL 32256 | 2019-05-13 |
| 1003479726 | Nichole Bashara | Behavior Technician | 8383 Baymeadows Rd, Jacksonville, FL 32256 | 2019-04-18 |
| Find all providers in zip 32256 | ||||
| Taxonomy Code | 1223P0700X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Prosthodontics |
| That branch of dentistry pertaining to the restoration and maintenance of oral functions, comfort, appearance and health of the patient by the restoration of natural teeth and/or the replacement of missing teeth and contiguous oral and maxillofacial tissues with artificial substitutes. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932728078 | Mohammad Reza Azari Samani | Dentist | 14453 Beach Blvd Ste 100, Jacksonville, FL 32250-2081 | 2020-04-09 |
| 1215390216 | Noel Rodriguez | Dentist | Naval Branch Health Clinic Nas Jax, Bldg 9 64, Birmingham Ave., Jacksonville, FL 32214-0001 | 2016-03-29 |
| 1588871289 | William Raymond Gielincki Jr. | Dentist | 6855 Belfort Oaks Pl, Jacksonville, FL 32216-6242 | 2007-05-16 |
| 1114059201 | Reza Azari Samani, Dds Pa | Dentist | 14453 Beach Blvd., Suite 100, Jacksonville, FL 32250 | 2007-03-12 |
| 1215951132 | Donald L. Smitha | Dentist | 812 Alderman Rd, Jacksonville, FL 32211-6102 | 2006-07-26 |
| 1083678262 | Eric M Olson | Dentist | 2078 Rogero Rd, Jacksonville, FL 32211-4119 | 2006-04-14 |
| 1023013281 | Wayne S. Barker | Dentist | 7740 Point Meadows Dr, Ste 4, Jacksonville, FL 32256-9180 | 2005-06-15 |
| 1265958128 | Diana Cole | Dentist | 554 Keily Street, Jacksonville, FL 32212 | 2017-08-22 |
| 1629449186 | Samuel Richards | Dentist | 554 Keily Street, Bur of Med & Surg Cred & Priv Division, Jacksonville, FL 23324 | 2015-10-09 |
| 1033528724 | Joseph Jarman | Dentist | 2005 Knight Lane Bldg H, Navy Medicine Support Command Attn: Medical Staff Svcs, Jacksonville, FL 32212-0140 | 2014-08-06 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32256 |
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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.