# BEACHWALK DENTAL, PA

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

## Provider details

- **NPI number:** 1518699826
- **Authorized official:** JESSICA NARDUCCI (GENERAL COUNSEL)
- **Authorized official phone:** (904) 626-6023

## Contact information

- **Practice address:** 855 COUNTY ROAD 210 WEST, SUITE A2 AND A3, ST. AUGUSTINE, FL 32259
- **Practice address phone:** (904) 549-9045
- **Mailing address:** 2801 SAINT JOHNS BLUFF RD S STE 101, JACKSONVILLE, FL 32246-3862
- **Mailing address phone:** (904) 998-7000

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/27/2022
- **Last updated:** 06/27/2022