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Organization
ST AUGUSTINE ORAL & FACIAL SURGICAL CENTER PA
Active
Organization
ST AUGUSTINE ORAL & FACIAL SURGICAL CENTER PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOUGLAS L JOHNSON DDS (OWNER)
(904) 460-0505
Entity
Organization
Contact information
Practice address
1301 PLANTATION ISLAND DR S, SUITE 101, ST AUGUSTINE, FL 32080-3108
(904) 460-0505
(904) 460-0506
Mailing address
PO BOX 7870, SPRINGDALE, AR 72766-7870
(479) 464-5824
(479) 725-2395
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DN15568
FL
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
DN15568
FL
2082S0099X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
DN15568
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DD5857
RAILROAD MEDICARE GROUP
FL
Enumeration date
05/23/2007
Last updated
06/23/2008
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