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Organization
LAKESIDE DENTAL SURGERY CENTER LLC
Active
Organization
LAKESIDE DENTAL SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREW WEAVER (PRACTICE ADMINISTRATOR)
(904) 395-7772
Entity
Organization
Contact information
Practice address
9143 PHILIPS HWY STE 515, JACKSONVILLE, FL 32256-1348
(904) 395-7772
Mailing address
3020 HARTLEY RD STE 210, JACKSONVILLE, FL 32257-8206
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
08/16/2022
Last updated
11/05/2024
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