Organization
SURFSIDE DENTAL SPECIALIST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRYSTAL L LESS (VP OF OPERATIONS)
(904) 998-7000
Entity
Organization
Contact information
Practice address
630 ATLANTIC BLVD, SUITE 7, NEPTUNE BEACH, FL 32266-4000
(904) 998-7000
(904) 998-7702
Mailing address
3545-1 ST. JOHNS BLUFF RD. S., SUITE 352, JACKSONVILLE, FL 32224
(904) 998-7000
(904) 998-7702
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223E0200X
Endodontics
Primary
—
—
1223G0001X
General Practice Dentistry
—
—
1223P0300X
Periodontics
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
Other
Enumeration date
02/20/2014
Last updated
01/26/2015
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