Organization
BRUSHES AND BRACKETS DENTAL STUDIO
Active
Parent organization
BRUSHES AND BRACKETS DENTAL STUDIO
Other names
Brushes and Brackets Dental Studio
Organization subpart
Yes
Provider details
NPI number
Legal business name
BRUSHES AND BRACKETS DENTAL STUDIO
Authorized official
DR. TANYA WALL DDS (OWNER)
(904) 751-5126
Entity
Organization
Contact information
Practice address
2255 DUNN AVE STE 700, JACKSONVILLE, FL 32218-4742
(904) 751-5126
(904) 751-5146
Mailing address
2255 DUNN AVE STE 700, JACKSONVILLE, FL 32218-4742
(904) 751-5126
(904) 751-5146
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103221100
—
FL
Enumeration date
10/28/2021
Last updated
10/28/2021
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