Organization
904 IMPLANTS AND DENTURES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM RUSSELL DMD (CO-OWNER)
(803) 665-6998
Entity
Organization
Contact information
Practice address
11645 BEACH BLVD STE 101, JACKSONVILLE, FL 32246-8496
(904) 999-9000
Mailing address
11645 BEACH BLVD STE 101, JACKSONVILLE, FL 32246-8496
(904) 999-9000
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
10/21/2021
Last updated
10/21/2021
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