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Organization
MODERN PERIODONTICS
Active
Organization
MODERN PERIODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANGELINE ANN KUZNIA DMD, MS (OWNER/DENTIST)
(904) 278-1175
Entity
Organization
Contact information
Practice address
3434 ATLANTIC BLVD, SUITE 1, JACKSONVILLE, FL 32207
(904) 398-1136
Mailing address
1409 KINGSLEY AVE, SUITE 9A, ORANGE PARK, FL 32073-4537
(904) 278-1175
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN15267
FL
122300000X
Dentist
DN17936
FL
Other
Enumeration date
04/15/2014
Last updated
04/17/2014
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