Organization
BAY MEADOWS DENTAL CARE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER KELLY (OWNER)
(410) 410-3031
Entity
Organization
Contact information
Practice address
4487 BAYMEADOWS RD, JACKSONVILLE, FL 32217-4716
(904) 513-1031
Mailing address
4487 BAYMEADOWS RD, JACKSONVILLE, FL 32217-4716
(904) 513-1031
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN19430
STATE LICENSE
FL
01
—
DN6191
STATE LICENSE
FL
Enumeration date
11/11/2021
Last updated
11/11/2021
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