Individual
AMY JOHANNA BOUVIER POBLENZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.M.D., M.S.
Contact information
Practice address
1023 ATLANTIC BLVD, ATLANTIC BEACH, FL 32233-3313
(904) 249-3104
(904) 249-3109
Mailing address
1023 ATLANTIC BLVD, ATLANTIC BEACH, FL 32233-3313
(904) 249-3104
(904) 249-3109
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
62078
CA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
9611
TN
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DN18750
FL
Other
Enumeration date
03/12/2013
Last updated
02/06/2018
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