Organization
FIRST COAST DENTAL GROUP, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTHONY RAMIRO CORRAL DMD (CEO)
(904) 247-0111
Entity
Organization
Contact information
Practice address
802 3RD ST, NEPTUNE BEACH, FL 32266-5018
(904) 247-0111
Mailing address
802 3RD ST, NEPTUNE BEACH, FL 32266-5018
(904) 247-0111
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN17063
FL
Other
Enumeration date
07/30/2012
Last updated
07/30/2012
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