Organization
FIRST COAST PERIODONTICS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WALTER ROBERT LEWIS WOOD D.M.D. (PRESIDENT)
(904) 807-9825
Entity
Organization
Contact information
Practice address
7711 BAYMEADOWS RD E, SUITE 7, JACKSONVILLE, FL 32256-9675
(904) 807-9825
(904) 807-9829
Mailing address
7711 BAYMEADOWS RD E, SUITE 7, JACKSONVILLE, FL 32256-9675
(904) 807-9825
(904) 807-9829
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DN11181
FL
Other
Enumeration date
08/11/2010
Last updated
08/11/2010
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