Individual
DR. BOUALI FREDERICK AMOLI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D. M.D.
Contact information
Practice address
5149 NORMANDY BLVD UNIT 4, JACKSONVILLE, FL 32205-4861
(904) 781-1201
Mailing address
5149 NORMANDY BLVD UNIT 4, JACKSONVILLE, FL 32205-4861
(904) 781-1201
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DN 21029
FL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DRP781
FL
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
ME119684
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
012224600
—
FL
Enumeration date
06/12/2009
Last updated
02/23/2015
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