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Organization
JACKSONVILLE FAMILY DENTISTRY AT SOUTHSIDE, INC
Active
Organization
JACKSONVILLE FAMILY DENTISTRY AT SOUTHSIDE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRYAN KEITH BLANKENSHIP DDS (PRESIDENT)
(904) 210-5348
Entity
Organization
Contact information
Practice address
8101 SOUTHSIDE BLVD STE 8, JACKSONVILLE, FL 32256-8005
(904) 641-2655
Mailing address
100 FAIRWAY PARK BLVD UNIT 512, PONTE VEDRA BEACH, FL 32082-2667
(904) 210-5348
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
16941
FL
Other
Enumeration date
10/17/2017
Last updated
10/17/2017
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