Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
NPIDirectory

Ponte Vedra Cosmetic Dentistry, PA

Organization General Practice Dentistry · NPI 1396000329

Ponte Vedra Cosmetic Dentistry, PA provides 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 Not confirmed with CMS for 14 years — call before visiting
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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