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Organization
ORANGE PARK DENTISTRY
Active
Organization
ORANGE PARK DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER KELLY (OWNER)
(904) 272-2438
Entity
Organization
Contact information
Practice address
784 BLANDING BLVD STE 110, ORANGE PARK, FL 32065-7724
(904) 272-2438
Mailing address
784 BLANDING BLVD STE 110, ORANGE PARK, FL 32065-7724
(904) 272-2438
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN19430
STATE LICENSE
FL
01
—
DN26279
STATE LICENSE
FL
Enumeration date
12/01/2021
Last updated
12/01/2021
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