# DENTAL PLACE OF JAX

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

## Provider details

- **NPI number:** 1932540390
- **Authorized official:** NICOLE M BUNCH D.D.S. (OWNER)
- **Authorized official phone:** (904) 563-3589

## Contact information

- **Practice address:** 5800 BEACH BLVD, \#A102, JACKSONVILLE, FL 32207-5120
- **Practice address phone:** (904) 860-3765
- **Mailing address:** 5800 BEACH BLVD, \#A102, JACKSONVILLE, FL 32207-5120
- **Mailing address phone:** (904) 860-3765

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DN17326 | FL | Yes |

## Other

- **Enumeration date:** 07/15/2013
- **Last updated:** 07/15/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 76637200 | — | FL |