# PEDIATRIC DENTAL ANESTHESIA ASSOCIATES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205099769
- **Authorized official:** DR. DENNIS R. STONE M.D. (PRESIDENT)
- **Authorized official phone:** (904) 230-3188

## Contact information

- **Practice address:** 3408 STATE ROAD 13, SAINT JOHNS, FL 32259-9270
- **Practice address phone:** (904) 230-3188
- **Practice address fax:** (904) 230-3189
- **Mailing address:** 3408 STATE ROAD 13, SAINT JOHNS, FL 32259-9270
- **Mailing address phone:** (904) 230-3188
- **Mailing address fax:** (904) 230-3189

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | L08000008171 | FL | Yes |

## Other

- **Enumeration date:** 07/05/2008
- **Last updated:** 07/05/2008