Organization
ESTHETIC & IMPLANT DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE C. JOHNS (DENTIST)
(561) 683-4488
Entity
Organization
Contact information
Practice address
8136 OKEECHOBEE BLVD., SUITE B, WEST PALM BEACH, FL 33411
(561) 683-4488
(561) 840-6491
Mailing address
8136 OKEECHOBEE BLVD., SUITE B, WEST PALM BEACH, FL 33411
(561) 683-4488
(561) 840-6491
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DN9243
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
073571000
—
FL
Enumeration date
05/14/2008
Last updated
05/11/2022
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