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Organization
PONTE VEDRA COSMETIC DENTISTRY, PA
Active
Organization
PONTE VEDRA COSMETIC DENTISTRY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KAMALA RUDOLPH (PRACTICE ADMINISTRATOR)
(904) 285-8407
Entity
Organization
Contact information
Practice address
100 PROFESSIONAL DR, PONTE VEDRA BEACH, FL 32082-6216
(904) 285-8407
(904) 285-5346
Mailing address
100 PROFESSIONAL DR, PONTE VEDRA BEACH, FL 32082-6216
(904) 285-8407
(904) 285-5346
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
07/05/2012
Last updated
07/05/2012
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