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BLUE WATER DENTAL OF ST. JOHNS
NPI 1821543513
Preferred Provider Organization in Ponte Vedra, FL

Active since August 23, 2016
460 TOWN PLAZA AVE, SUITE 210, PONTE VEDRA, FL 32081(904) 755-1966 Get Directions Write a Review

NPPES record last updated: August 23, 2016. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Blue Water Dental Of St. Johns NPPES

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

BLUE WATER DENTAL OF ST. JOHNS (NPI 1821543513) is a healthcare organization registered as a preferred provider organization in Ponte Vedra, Florida and active in the NPI registry since August 2016. The organization lists David Wallace Sorensen, Dentist/owner, as its authorized official.

NPPES Registry Identity

NPI1821543513
Entity TypeOrganization
Primary Taxonomy305R00000X
Legal Business NameBLUE WATER DENTAL OF ST. JOHNS
Location Address460 TOWN PLAZA AVE, SUITE 210Ponte Vedra, FL 32081-5139
Mailing Address334 Willow Winds PkwySaint Johns, FL 32259-7268 · (904) 755-1966
Phone(904) 755-1966
Organization SubpartNo
Authorized OfficialDavid Wallace SorensenDentist/owner · (904) 755-1966
Enumeration DateAugust 23, 2016
✔ NPI 1821543513 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPreferred Provider OrganizationManaged Care Organizations
Taxonomy Code305R00000X
License✔ Licensed in FL · DN20719
Definition
A group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level.
460 TOWN PLAZA AVE, Ponte Vedra, FL 32081
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Other Identifiers 1

Other1831508084FL · Individual Npi

Other Providers at the Same Location NPPES 4

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

DR. ANNETTE STRICKLAND VAN HORN PSY.D.
Psychologist (Clinical)
460 TOWN PLAZA AVE, SUITE 230
PONTE VEDRA, FL 32081
St. Johns County (904) 297-5565
KATHRYN FLEMING HANSON PSY.D.
Psychologist (Clinical)
460 TOWN PLAZA AVE
PONTE VEDRA, FL 32081
St. Johns County (904) 834-9292
DR. DAVID WALLACE SORENSEN DMD
Dentist
460 TOWN PLAZA AVE, SUITE 210
PONTE VEDRA, FL 32081
St. Johns County (904) 395-7771
DR. MICHELE BRENNEMAN PH.D.
Psychologist
460 TOWN PLAZA AVE, SUITE 230
PONTE VEDRA, FL 32081
St. Johns County (904) 671-6237

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 Blue Water Dental Of St. Johns's NPI number?

The NPI number for Blue Water Dental Of St. Johns is 1821543513. It was assigned to this organization in the NPPES registry on August 23, 2016.

Where is Blue Water Dental Of St. Johns located?

Blue Water Dental Of St. Johns is located at 460 Town Plaza Ave Suite 210, Ponte Vedra, FL 32081. The listed phone number is (904) 755-1966.

What is Blue Water Dental Of St. Johns's specialty?

The primary specialty registered for this NPI is Preferred Provider Organization with taxonomy code 305R00000X.

When was this NPI record last updated?

The NPPES record for Blue Water Dental Of St. Johns was last updated on August 23, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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.