# JACKSONVILLE ORAL SURGERY PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871123984
- **Authorized official:** VICTORIA JOHNSON (CRO)
- **Authorized official phone:** (941) 444-0558

## Contact information

- **Practice address:** 2047 PARK ST, JACKSONVILLE, FL 32204-3809
- **Practice address phone:** (904) 388-7665
- **Mailing address:** 2047 PARK ST, JACKSONVILLE, FL 32204-3809
- **Mailing address phone:** (904) 388-7665

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 01/17/2020
- **Last updated:** 07/21/2026