=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336449545
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MCALPIN DENTAL GROUP P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/22/2010
-----------------------------------------------------
Last Update Date | 10/22/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2301 PARK AVE SUITE 201
-----------------------------------------------------
City | ORANGE PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-269-1048
-----------------------------------------------------
Fax | 904-269-0109
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2301 PARK AVE SUITE 201
-----------------------------------------------------
City | ORANGE PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-269-1048
-----------------------------------------------------
Fax | 904-269-0109
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GENERAL DENTIST
-----------------------------------------------------
Name | DR. RYAN D MCALPIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 904-269-1048
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DN8008
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DN10773
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DN18278
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------