1. Home
  2. Directory
  3. Florida
  4. Saint Augustine
  5. Clinic Center
  6. NPI Profile

PONCE DE LEON FAMILY DENTISTRY
NPI 1801059480
Clinic/Center - Dental in Saint Augustine, FL

Active since July 03, 2008
4 SAINT JOHNS MEDICAL PK DR, SAINT AUGUSTINE, FL 32086(904) 797-9009(904) 797-9057 Get Directions Write a Review

NPPES record last updated: July 3, 2008. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Ponce De Leon Family Dentistry NPPES

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

PONCE DE LEON FAMILY DENTISTRY (NPI 1801059480) is a healthcare organization registered as a dental in Saint Augustine, Florida and active in the NPI registry since July 2008. The organization lists Theodore Daniel Haeussner, Dentist, as its authorized official.

NPPES Registry Identity

NPI1801059480
Entity TypeOrganization
Primary Taxonomy261QD0000X
Legal Business NamePONCE DE LEON FAMILY DENTISTRY
Location Address4 SAINT JOHNS MEDICAL PK DRSaint Augustine, FL 32086-5298
Mailing Address4 Saint Johns Medical Pk DrSaint Augustine, FL 32086-5298 · (904) 797-9009 · Fax (904) 797-9057
Phone(904) 797-9009
Fax(904) 797-9057
Organization SubpartNo
Authorized OfficialTheodore Daniel HaeussnerDentist · (904) 797-8247
Enumeration DateJuly 3, 2008
✔ NPI 1801059480 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · DentalAmbulatory Health Care Facilities
Taxonomy Code261QD0000X
4 SAINT JOHNS MEDICAL PK DR, Saint Augustine, FL 32086
Open in Google Maps ↗

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. THEODORE DANIEL HAEUSSNER D.M.D.
Dentist
4 SAINT JOHNS MEDICAL PK DR
SAINT AUGUSTINE, FL 32086
St. Johns County (904) 797-9009

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 Ponce De Leon Family Dentistry's NPI number?

The NPI number for Ponce De Leon Family Dentistry is 1801059480. It was assigned to this organization in the NPPES registry on July 3, 2008.

Where is Ponce De Leon Family Dentistry located?

Ponce De Leon Family Dentistry is located at 4 Saint Johns Medical Pk Dr, Saint Augustine, FL 32086. The listed phone number is (904) 797-9009.

What is Ponce De Leon Family Dentistry's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Dental, with taxonomy code 261QD0000X.

When was this NPI record last updated?

The NPPES record for Ponce De Leon Family Dentistry was last updated on July 3, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years 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.