# JACKSONVILLE DENTAL SPECIALISTS

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** JACKSONVILLE DENTAL SPECIALISTS
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1568915387
- **Legal business name:** JACKSONVILLE DENTAL SPECIALISTS
- **Authorized official:** LYDIA CUEVAS (PRACTICE COORDINATOR)
- **Authorized official phone:** (904) 683-4781

## Contact information

- **Practice address:** 11512 LAKE MEAD AVE, STE. 532, JACKSONVILLE, FL 32256-9680
- **Practice address phone:** (904) 460-4201
- **Practice address fax:** (904) 683-3914
- **Mailing address:** 11512 LAKE MEAD AVE, STE. 532, JACKSONVILLE, FL 32256-9680
- **Mailing address phone:** (904) 460-4201
- **Mailing address fax:** (904) 683-3914

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0300X | Periodontics | DN16648 | FL | — |
| 1223P0700X | Prosthodontics | DN18280 | FL | Yes |

## Other

- **Enumeration date:** 07/28/2016
- **Last updated:** 07/28/2016