Individual
BASIL JAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5491 DOLPHIN POINT BLVD, JACKSONVILLE, FL 32211-3221
(904) 312-0960
Mailing address
7170 SW 22ND ST, DAVIE, FL 33317-7122
(904) 312-0960
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DN28716
FL
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
28716
FL
Other
Enumeration date
06/22/2024
Last updated
05/05/2025
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