SEACREST DENTAL (NPI# 1366844854) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366844854 |
| Entity Type | Organization |
| Organization Name | SEACREST DENTAL |
| Practice Address |
5399 E County Highway 30a Santa Rosa Beach FL 32459-6717 |
| Practice Telephone | 8502313736 |
| Enumeration Date | 2014-09-16 |
| Last Update Date | 2014-09-16 |
| Authorized Official Name | DR. FRED RUDER (OWNER) |
| Authorized Official Telephone | 8502313736 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
DN 20813 | FL | Ambulatory Health Care Facilities |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | SEACREST DENTAL SERVICES LLC | 66 N Holiday Rd, Miramar Beach, FL 32550-6936 |
| Street Address |
5399 E COUNTY HIGHWAY 30A |
| City | SANTA ROSA BEACH |
| State | FL |
| Zip Code | 32459-6717 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487761086 | Steven J Leikin | Dentist | 5399 E County Highway 30a, Suite 1, Santa Rosa Beach, FL 32459-6717 | 2006-08-23 |
| 1124510557 | Ross Jacob Ruder | Dentist | 5399 E County Highway 30a, Santa Rosa Beach, FL 32459-6717 | 2018-06-01 |
| 1710022827 | Seagrove Beach Medical Clinic Inc | Clinic/Center | 5399 E County Highway 30a, Suite 5, Santa Rosa Beach, FL 32459-6717 | 2007-02-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336740521 | Gary Mcfadyen | Hearing Instrument Specialist | 395 E. Point Washington, Santa Rosa Beach, FL 32459 | 2020-11-04 |
| 1235783218 | Camilla Ruth Chacon | Nurse Practitioner | 4821 Highway 98 West, Suite 104, Santa Rosa Beach, FL 32459 | 2019-07-29 |
| 1942797287 | Lauren Mank | Assistant Behavior Analyst | 67 Hiker St Fl 32459, Santa Rosa Beach, FL 32459 | 2018-04-20 |
| 1740781137 | Imaging Institute LLC | Radiology | 6757 Us Hwy 98 W Ste 301, Santa Rosa Beach, FL 32459 | 2018-02-22 |
| 1023540648 | Emerald Coast Medical Supplies LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 48 Bald Eagle Dr, Santa Rosa Beach, FL 32459 | 2017-04-02 |
| 1215485230 | Tamra Snook | Social Worker | 156 N County Highway 393 Unit 1, Santa Rosa Beach, FL 32459 | 2016-09-19 |
| 1437605730 | Alexandra Armstrong | Physical Therapist | 249 Mack Bayou Loop Ste 101, Santa Rosa Beach, FL 32459 | 2016-08-28 |
| 1386097749 | Itetra Smith | Behavior Technician | 67 Hiker St, Santa Rosa Beach, FL 32459 | 2016-07-20 |
| 1730527086 | Emerald Coast Medical Supplies LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 48 Bald Eagle Drive, Santa Rosa Beach, FL 32459 | 2013-06-10 |
| 1114269768 | Pamela Jean Skaff | Dentist | 101 Lecom Way, Defuniak Springs, FL 32459 | 2013-03-21 |
| Find all providers in zip 32459 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942764287 | Tmj & Sleep Center LLC | Clinic/Center | 6757 Us Highway 98 W Ste 302, Santa Rosa Beach, FL 32459-4780 | 2019-01-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699376525 | Hoffmann Holdings Inc | Clinic/Center | 515 Semoran Blvd Ste 1000, Casselberry, FL 32707-5341 | 2020-11-06 |
| 1811598238 | Dental Plus Management, LLC | Clinic/Center | 16 Ne 2nd Ave, Deerfield Beach, FL 33441-3504 | 2020-11-03 |
| 1750981452 | Smillie Dental Pllc | Clinic/Center | 5537 S Williamson Blvd Ste 675, Port Orange, FL 32128-8314 | 2020-10-30 |
| 1609476027 | R & R Dentistry Pa | Clinic/Center | 6290 Linton Blvd Unit 202, Delray Beach, FL 33484-6409 | 2020-10-26 |
| 1295334126 | Friedman Dental Group Miami, Pllc | Clinic/Center | 1717 N Bayshore Dr Ste 219, Miami, FL 33132-1196 | 2020-10-21 |
| 1376142547 | Trm Global Enterprise,llc. | Clinic/Center | 145 Crawl Key Ct, Deland, FL 32720-3951 | 2020-10-20 |
| 1568060762 | Bawany LLC | Clinic/Center | 15130 Springview St, Tampa, FL 33624-2332 | 2020-10-12 |
| 1992312730 | Rocent Dental Care, Inc. | Clinic/Center | 1 Sw 129th Ave Ste 406, Pembroke Pines, FL 33027-1718 | 2020-09-25 |
| 1730795857 | Kind Smiles Dental Health | Clinic/Center | 11155 State Road 70 E, Lakewood Ranch, FL 34202 | 2020-09-23 |
| 1952916306 | Simmons Services LLC | Clinic/Center | 2500 Sw 107th Ave Ste 45, Miami, FL 33165-2492 | 2020-09-12 |
| Find all providers with the same taxonomy | ||||
| City | SANTA ROSA BEACH |
| Zip Code | 32459 |
Please comment or provide details below to improve the information on SEACREST DENTAL.
| 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.