Organization
JACKSONVILLE DENTAL SPECIALISTS
Active
Parent organization
JACKSONVILLE DENTAL SPECIALISTS
Organization subpart
Yes
Provider details
NPI number
Legal business name
JACKSONVILLE DENTAL SPECIALISTS
Authorized official
LYDIA CUEVAS (PRACTICE COORDINATOR)
(904) 683-4781
Entity
Organization
Contact information
Practice address
11512 LAKE MEAD AVE, STE. 532, JACKSONVILLE, FL 32256-9680
(904) 460-4201
(904) 683-3914
Mailing address
11512 LAKE MEAD AVE, STE. 532, JACKSONVILLE, FL 32256-9680
(904) 460-4201
(904) 683-3914
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
DN16648
FL
1223P0700X
Prosthodontics
Primary
DN18280
FL
Other
Enumeration date
07/28/2016
Last updated
07/28/2016
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