Unknown Individual – Dentist, NPI 1407966542

Unknown Individual is a healthcare provider. based in St augustine, Florida. specializing in Dentist. They hold a License No. 8348 (KY). The NPI Number for Unknown Individual is 1407966542

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1407966542
Phone
(904) 994-4936
Address
117 SAINT ANDREWS PLACE DR
Deactivation Date
9 August 2023
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience32
Completeness75
Years active:0State licenses:3Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 117 SAINT ANDREWS PLACE DR

    ST AUGUSTINE, FL 320920774

    Phone: (904) 994-4936

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

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Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 32092)

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Reviews

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Frequently asked questions

What is Unknown Individual's NPI number?
Unknown Individual's NPI is 1407966542 — the number used across U.S. healthcare to identify this provider.
Does inactive status mean Unknown Individual stopped practicing?
Inactive registry status can reflect deactivation, consolidation, or data lag.
How would a patient describe Unknown Individual's focus?
For Unknown Individual, the primary taxonomy reads as Dentist. Clinical services aligned with this taxonomy classification.
Is Unknown Individual associated with St Augustine?
Public fields place Unknown Individual around St Augustine, Florida. Always confirm the exact site before visiting.
What does 2 location(s) imply?
2 practice locations appear in the available data.