Organization
SOUTHSIDE DERMATOLOGY, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY TRINH PENTEL M.D. (PRESIDENT)
(904) 880-0622
Entity
Organization
Contact information
Practice address
4727 SUNBEAM RD, SUITE 101, JACKSONVILLE, FL 32257-6107
(904) 880-0622
(904) 880-0623
Mailing address
4727 SUNBEAM RD, SUITE 101, JACKSONVILLE, FL 32257-6107
(904) 880-0622
(904) 880-0623
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME16473
FL
Other
Enumeration date
05/29/2008
Last updated
07/02/2014
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