Newly Listed Provider — this NPI profile has been added to the NPI registry within the last 90 days.

WELLTIDE ORTHODONTICS LLC
NPI 1568370104
Dentist - Orthodontics and Dentofacial Orthopedics in St Augustine, FL

Active since September 01, 2026
420 PASEO REYES DR, ST AUGUSTINE, FL 32095(904) 671-6996(904) 671-7002 Get Directions Write a Review

NPPES record added: September 1, 2026. Verified against the NPPES registry weekly; last sync: September 06, 2026.

About Welltide Orthodontics Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WELLTIDE ORTHODONTICS LLC (NPI 1568370104) is a healthcare organization registered as an orthodontics and dentofacial orthopedics in St Augustine, Florida and active in the NPI registry since September 2026. The organization lists Susan Sara Podray, Orthodontist, as its authorized official.

NPPES Registry Identity

NPI1568370104
Entity TypeOrganization
Primary Taxonomy1223X0400X
Legal Business NameWELLTIDE ORTHODONTICS LLC
Location Address420 PASEO REYES DRSt Augustine, FL 32095-8558
Mailing Address420 Paseo Reyes DrSt Augustine, FL 32095-8558 · (904) 671-6996 · Fax (904) 671-7002
Fax(904) 671-7002
Organization SubpartNo
Authorized OfficialSusan Sara PodrayOrthodontist · (678) 787-3863
Enumeration DateSeptember 1, 2026
NPPES CertifiedSeptember 1, 2026
NPI 1568370104 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyDentist · Orthodontics and Dentofacial OrthopedicsDental Providers
Taxonomy Code1223X0400X
Definition
That area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of functional forces within the craniofacial complex. Major responsibilities of orthodontic practice include the diagnosis, prevention, interception and treatment of all forms of malocclusion of the teeth and associated alterations in their surrounding structures; the design, application and control of functional and corrective appliances; and the guidance of the dentition and its supporting structures to attain and maintain optimum occlusal relations in physiologic and esthetic harmony among facial and cranial structures.
420 PASEO REYES DR, St Augustine, FL 32095

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Welltide Orthodontics LLC's NPI number?

The NPI number for Welltide Orthodontics LLC is 1568370104. It was assigned to this organization in the NPPES registry on September 1, 2026.

Where is Welltide Orthodontics LLC located?

Welltide Orthodontics LLC is located at 420 Paseo Reyes Dr, St Augustine, FL 32095. The listed phone number is (904) 671-6996.

What is Welltide Orthodontics LLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Orthodontics and Dentofacial Orthopedics, with taxonomy code 1223X0400X.

When was this NPI record last updated?

The NPPES record for Welltide Orthodontics LLC was last updated on September 1, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.