Organization
FIRST COAST ORAL & FACIAL SURGERY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS E STAKEM D.D.S., M.D. (PRESIDENT)
(904) 529-8889
Entity
Organization
Contact information
Practice address
319 W TOWN PLACE, SUITE 2, ST AUGUSTINE, FL 32092
(904) 529-8889
Mailing address
319 WEST TOWN PLACE #2, ST. AUGUSTINE, FL 32092
(904) 529-8889
(904) 529-8893
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
—
Other
Enumeration date
05/24/2012
Last updated
05/24/2012
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