KEVIN R JURECKO (NPI# 1578615027) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578615027 |
| Entity Type | Individual |
| Full Name | KEVIN R JURECKO |
| Credential | DDS |
| Practice Address |
2086 Sw Main Blvd Suite #113 Lake City FL 32025-0005 |
| Practice Telephone | 3867586050 |
| Practice Fax Number | 3867587742 |
| Mailing Telephone | 3867586050 |
| Mailing Fax Number | 3867587742 |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223E0200X |
Dentist Specialization: Endodontics |
0005418 | FL | Dental Providers |
| Street Address |
2086 SW MAIN BLVD SUITE #113 |
| City | LAKE CITY |
| State | FL |
| Zip Code | 32025-0005 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598318990 | Kayli Rian Kvistad | Specialist/Technologist | 2086 Sw Main Blvd, Lake City, FL 32025-0005 | 2019-07-24 |
| 1235341439 | Sylvia Willis Douglas | Massage Therapist | 2086 Sw Main Blvd, Lake City, FL 32025-0005 | 2007-05-03 |
| 1912119116 | Jennifer Brooke Hagler I | Massage Therapist | 2086 Sw Main Blvd, Lake City, FL 32025-0005 | 2007-05-03 |
| 1538176490 | Francisco J Ravelo | Pathology | 2086 Sw Main Blvd, Suite 103, Lake City, FL 32025-0005 | 2006-08-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801438353 | Jennifer Bennett | Pharmacist | 347 Sw Main Blvd Suite 102, Lake City, FL 32025 | 2019-10-16 |
| 1700352838 | Robert J Sansouci IIi IIi | Physical Therapy Assistant | 560 Sw Mcfarlane Ave, Lake City, Fl, 32025, Lake City, FL 32025 | 2018-10-16 |
| 1316442783 | Emily Bailey | Developmental Therapist | 2126 Sw Sisters Welcome Rd, Lake City, FL 32025 | 2018-03-28 |
| 1811446370 | Michelle Hart | Behavioral Analyst | 260 S. Marion Avenue, Bldg. A, Suite 135, Lake City, FL 32025 | 2016-09-26 |
| 1922467646 | Irene Aponte Moreno | Nurse Practitioner | 440 Sw Perimeter Glen, Lake City, FL 32025 | 2016-02-23 |
| 1093186777 | Decarlos Scippio | Counselor | 619 Sw Baya Drive Suite 102, Lake City, FL 32025 | 2015-10-07 |
| 1497132476 | Jamecia Legree | Registered Nurse | 800 Sw Symphony Loop, Bldg 15 Apt 204, Lake City, FL 32025 | 2015-04-29 |
| 1306249149 | Mercy Home Assisted Living Facility LLC | Assisted Living Facility | 184 S.e. Beech Street, Lake City, FL 32025 | 2014-10-08 |
| 1598174344 | Karen Mcdonald | Developmental Therapist | 4523 Se County Road 252, Lake City, FL 32025 | 2014-08-06 |
| 1275944126 | Mohammad Ali Faisal Mdpa | Specialist | 1283 Sw State Rd 47, Ste 104, Lake City, FL 32025 | 2014-05-14 |
| Find all providers in zip 32025 | ||||
| Taxonomy Code | 1223E0200X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Endodontics |
| The branch of dentistry that is concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic and clinical sciences including biology of the normal pulp, the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588950349 | Associated Endodontists of Lake City | Dentist | 2086 Sw Main Blvd Ste 113, Lake City, FL 32025-0006 | 2011-06-21 |
| 1487852547 | Michael Carraway Foreman | Dentist | 239 Sw Professional Gln, Lake City, FL 32025-1105 | 2007-07-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922608736 | Mid-florida Endodontics - Winter Garden Pa | Dentist | 15815 Shaddock Drive, Unit-3, Winter Garden, FL 34787 | 2020-10-30 |
| 1154935799 | Orbit Dental Management Pa | Dentist | 1453 Nw Saint Lucie West Blvd, Port St Lucie, FL 34986-1968 | 2020-09-01 |
| 1790397370 | Bruce D. Schulman, Dds Pa | Dentist | 10150 Hagen Ranch Rd Ste 200, Boynton Beach, FL 33437-3776 | 2020-08-17 |
| 1770117525 | Volusia Endodontics Pa | Dentist | 2751 Enterprise Rd Ste 211, Orange City, FL 32763-8262 | 2020-03-02 |
| 1417587130 | Advanced Endodontics of Winter Park, Pa | Dentist | 400 W Morse Blvd Ste 102, Winter Park, FL 32789-4259 | 2020-01-22 |
| 1699326603 | North Central Florida Endodontics,pllc | Dentist | 48 Se 16th Ave, Ocala, FL 34471-2521 | 2019-09-23 |
| 1396395919 | Stephen L. Goldfaden, Dds,pa | Dentist | 1905 Nw 13th St Ste 2, Gainesville, FL 32609-3414 | 2019-09-16 |
| 1649820630 | Ponte Vedra Endodontics | Dentist | 822 A1a North, Ste 314, Ponte Vedra Beach, FL 32082 | 2019-09-12 |
| 1437707197 | John Zachary Reynolds | Dentist | 3180 Redeemer Way, New Port Richey, FL 34655-4245 | 2019-08-27 |
| 1497307987 | Bradley Sleeth | Dentist | 942 Goldridge Ct, Orange Park, FL 32065-6259 | 2019-07-15 |
| Find all providers with the same taxonomy | ||||
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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.