Organization
GUIDED SMILES PROSTHODONTICS & IMPLANT CENTER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALONZO CARLOS BLACKMON DDS (AUTHORIZED OFFICIAL)
(904) 395-5501
Entity
Organization
Contact information
Practice address
153 FORT WADE ROAD, STE 100, PONTE VEDRA, FL 32081
(904) 395-5501
Mailing address
153 FORT WADE ROAD, STE 100, PONTE VEDRA, FL 32081
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
09/30/2022
Last updated
09/30/2022
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