Organization
JACKSONVILLE FAMILY DENTISTRY AT SOUTHSIDE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRYAN KEITH BLANKENSHIP DDS (PRESIDENT)
(904) 210-5348
Entity
Organization
Contact information
Practice address
8101 SOUTHSIDE BLVD STE 8, JACKSONVILLE, FL 32256-8005
(904) 641-2655
Mailing address
100 FAIRWAY PARK BLVD UNIT 512, PONTE VEDRA BEACH, FL 32082-2667
(904) 210-5348
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
16941
FL
Other
Enumeration date
10/17/2017
Last updated
10/17/2017
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