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Organization
JACKSONVILLE ORAL SURGERY PLLC
Active
Organization
JACKSONVILLE ORAL SURGERY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICTORIA JOHNSON (CRO)
(941) 444-0558
Entity
Organization
Contact information
Practice address
2047 PARK ST, JACKSONVILLE, FL 32204-3809
(904) 388-7665
Mailing address
2047 PARK ST, JACKSONVILLE, FL 32204-3809
(904) 388-7665
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
01/17/2020
Last updated
07/21/2026
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