Organization
A SMILE RESORT, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARTHA G LAY (OFFICE MANAGER)
(904) 268-2011
Entity
Organization
Contact information
Practice address
3676 CROWN POINT CT, JACKSONVILLE, FL 32257-5966
(904) 268-2011
Mailing address
3676 CROWN POINT CT, JACKSONVILLE, FL 32257-5966
(904) 268-2011
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN0010421
FL
1223G0001X
General Practice Dentistry
DN16658
FL
Other
Enumeration date
05/22/2007
Last updated
08/22/2020
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