Individual
JAKE RYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4327 US 1 S, ST AUGUSTINE, FL 32086-7278
(904) 494-8630
Mailing address
4327 US 1 S, ST AUGUSTINE, FL 32086-7278
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN28000
FL
Other
Enumeration date
07/06/2023
Last updated
07/24/2023
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