Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Ponce De Leon Family Dentistry

Organization Dental Clinic/Center · NPI 1801059480

Ponce De Leon Family Dentistry is a Dental Clinic/Center in Saint Augustine, Florida. Registered with an NPI since 2008.

In the registry since
2008

Practice location Address checks out

4 Saint Johns Medical Pk Dr
Saint Augustine, FL 32086-5298
Phone: (904) 797-9009
Fax: (904) 797-9057
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dental Clinic/Center (primary) Taxonomy 261QD0000X

Record details

NPI number1801059480
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Theodore Haeussner — Dentist · (904) 797-8247
NPI enumeratedJuly 3, 2008
Last updated in NPPESJuly 3, 2008
Mailing address4 Saint Johns Medical Pk Dr, Saint Augustine, FL 32086-5298

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