DR. TODD TRABOR PUCKETT (NPI# 1689649931) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689649931 |
| Entity Type | Individual |
| Full Name | DR. TODD TRABOR PUCKETT |
| Credential | D.M.D. |
| Practice Address |
943 Cesery Blvd Building # A Jacksonville FL 32211-5635 |
| Practice Telephone | 9047435604 |
| Practice Fax Number | 9047441490 |
| Mailing Telephone | 9047435604 |
| Mailing Fax Number | 9047441490 |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2015-04-06 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
DN18217 | FL | Dental Providers |
| N | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
2901017095 | MI | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215374608 | Todd Puckett | Counselor | 6 Skylark St, Dayton, TX 77535-1538 | 2013-05-27 |
| Street Address |
943 CESERY BLVD BUILDING # A |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32211-5635 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295250165 | Wanda Banks | Counselor | 943 Cesery Blvd, Jacksonville, FL 32211-5635 | 2017-08-11 |
| 1104341601 | Howard Evans Weightman IIi | Counselor | 943 Cesery Blvd, Ste G, Jacksonville, FL 32211 | 2017-08-07 |
| 1629502471 | Chantel Williams | Counselor | 943 Cesery Blvd, Suite G, Jacksonville, FL 32211-5635 | 2017-04-19 |
| 1144769712 | Howard Wright | Counselor | 943 Cesery Blvd, Building G, Jacksonville, FL 32211-5635 | 2017-02-15 |
| 1245587609 | Samuel Belton Gaskins Iv | Dentist | 943 Cesery Blvd, Building B, Jacksonville, FL 32211-5635 | 2012-08-04 |
| 1104193119 | James November Phd Pa | Psychologist | 943 Cesery Blvd, Jacksonville, FL 32211-5635 | 2011-11-18 |
| 1346433638 | Lisa Vanetti | Counselor | 943 Cesery Blvd, Suite G, Jacksonville, FL 32211-5635 | 2007-08-21 |
| 1568671485 | Kathy Ann Marks | Social Worker | 943 Cesery Blvd, Building G, Jacksonville, FL 32211-5635 | 2007-05-21 |
| 1457499410 | Eugene Katibah | Dentist | 943 Cesery Blvd, Jacksonville, FL 32211-5635 | 2007-02-02 |
| 1497893697 | H. Raymond Klein, D.d.s., P.a. | Dentist | 943 Cesery Blvd, Jacksonville, FL 32211-5635 | 2007-02-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457951758 | Ebs Childrens Therapy - Fl LLC | Behavioral Analyst | 5491 Dolphin Point Blvd, Jacksonville, FL 32211 | 2020-10-27 |
| 1700412822 | Marie Vernal | Social Worker | 6051 Arlington Expressway Suite 169, Jacksonville, FL 32211 | 2020-03-20 |
| 1992336895 | Dolphin Pointe Health Care, LLC | Skilled Nursing Facility | 5355 Dolphin Point Rd., Jacksonville, FL 32211 | 2020-01-29 |
| 1366089641 | Prophetic Healing Deliverance Ministry of Mysteries, Inc | Counselor | 8550-2 Lone Star Road, Jacksonville, FL 32211 | 2019-12-05 |
| 1922656370 | Timothy Richard Barron | Behavior Technician | 5633 Clifton Ln, Jacksonville, FL 32211 | 2019-08-29 |
| 1023583325 | Linnzi Marks | Behavioral Analyst | 6014 Wateredge Ln, Jacksonville, FL 32211 | 2018-10-12 |
| 1780160192 | Ganesh Healthcare of Jax LLC | Alzheimer Center (Dementia Center) | 644 Cesery Blvd Ste 150, Jacksonville, FL 32211 | 2018-07-18 |
| 1902397276 | Chandra Harris Washington | In Home Supportive Care | 2712 Gaillardia Rd, Jacksonville, FL 32211 | 2018-05-22 |
| 1043730062 | Monica R Iskander | Dentist | 465 University Blvd N, Jacksonville, FL 32211 | 2017-06-21 |
| 1205366895 | Lilibeth Bundang Adona | Custodial Care Facility | 1818 Townsend Blvd, Jacksonville, FL 32211 | 2017-06-15 |
| Find all providers in zip 32211 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154760411 | Tyler J Holley | Dentist | University of Florida- Jacksonville, 653-1 West 8th Street, Jacksonville, FL 32209 | 2013-06-20 |
| 1851602734 | Carlo Enrico Guevara | Dentist | 4540 Southside Blvd Ste 1001, Jacksonville, FL 32216-5495 | 2010-06-25 |
| 1306073754 | Bouali Frederick Amoli | Dentist | 5149 Normandy Blvd Unit 4, Jacksonville, FL 32205-4861 | 2009-06-12 |
| 1154555035 | Salam Omar Salman | Dentist | 653 W. 8th Street, Uf - Jacksonville Dept. of Oral & Maxillofacial Surgery, Jacksonville, FL 32209 | 2009-05-07 |
| 1316151301 | Scott Roberts Sklenicka | Dentist | 2511 Saint Johns Bluff Rd S, Suite 207, Jacksonville, FL 32246-2346 | 2007-05-09 |
| 1851417406 | North Florida Oral & Facial Surgery, P.a. | Dentist | 11481 Old Saint Augustine Rd Ste 203, Jacksonville, FL 32258-1475 | 2007-03-22 |
| 1992832059 | Vanni Russ Strenta | Dentist | 3914 Blanding Blvd, Jacksonville, FL 32210-5413 | 2007-02-27 |
| 1184760480 | Gregory Joseph Groshan | Dentist | 3007 Hartley Rd, Jacksonville, FL 32257-6201 | 2007-01-30 |
| 1477606267 | Gregory W Hartley | Dentist | 4181 Southpoint Dr E, Suite 200, Jacksonville, FL 32216-0993 | 2007-01-18 |
| 1366591265 | Pairot Tayapongsak | Dentist | 7101 Normandy Blvd, Jacksonville, FL 32205-6211 | 2007-01-09 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32211 |
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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.