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

Ponte Vedra Cosmetic Dentistry, PA

Organization General Practice Dentistry · NPI 1396000329

Ponte Vedra Cosmetic Dentistry, PA is a General Practice Dentistry in Ponte Vedra Beach, Florida. Registered with an NPI since 2012.

In the registry since
2012
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

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Practice location Address checks out

100 Professional Dr
Ponte Vedra Beach, FL 32082-6216
Phone: (904) 285-8407
Fax: (904) 285-5346
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Dentistry (primary) Taxonomy 1223G0001X

Record details

NPI number1396000329
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Kamala Rudolph — Practice Administrator · (904) 285-8407
NPI enumeratedJuly 5, 2012
Last updated in NPPESJuly 5, 2012
Mailing address100 Professional Dr, Ponte Vedra Beach, FL 32082-6216

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