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Organization
LARROC DENTAL
Active
Organization
LARROC DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY CORRAL DMD (OWNER)
(904) 442-6000
Entity
Organization
Contact information
Practice address
7768 OZARK DR, JACKSONVILLE, FL 32256-5839
(904) 442-6000
(904) 503-1440
Mailing address
7768 OZARK DR, JACKSONVILLE, FL 32256-5839
(904) 442-6000
(904) 503-1440
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
DN14472
FL
1223G0001X
General Practice Dentistry
Primary
DN17063
FL
1223G0001X
General Practice Dentistry
DN2788
FL
124Q00000X
Dental Hygienist
DH23171
FL
124Q00000X
Dental Hygienist
DH24089
FL
124Q00000X
Dental Hygienist
DH9959
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1275513434
—
FL
05
—
1730600958
—
FL
05
—
1992831341
—
FL
Enumeration date
04/03/2018
Last updated
04/03/2018
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