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Organization
THE VILLAGE DENTIST
Active
Organization
THE VILLAGE DENTIST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELE GIBSON (OFFICE MANAGER)
(904) 940-7990
Entity
Organization
Contact information
Practice address
425 W TOWN PL, SUITE 106, ST AUGUSTINE, FL 32092-3661
(904) 940-7990
(904) 940-7991
Mailing address
425 W TOWN PL, SUITE 106, ST AUGUSTINE, FL 32092-3661
(904) 940-7990
(904) 940-7991
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN11714
FL
Other
Enumeration date
02/03/2011
Last updated
02/03/2011
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