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Organization
MARIETTA DENTAL GROUP
Active
Organization
MARIETTA DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRYSTAL L LESS (VP OF OPERATIONS)
(904) 998-7000
Entity
Organization
Contact information
Practice address
8209 W. BEAVER ST., SUITE 100, JACKSONVILLE, FL 32220
(904) 998-7000
(904) 998-7702
Mailing address
3545-1 ST. JOHNS BLUFF RD. S., SUITE 352, JACKSONVILLE, FL 32224
(904) 998-7000
(904) 998-7702
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN15716
FL
Other
Enumeration date
08/15/2014
Last updated
01/26/2015
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