Organization
SURFSIDE DENTAL CENTER, PA.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRYSTAL L LESS (VP OF OPERATIONS)
(904) 998-7000
Entity
Organization
Contact information
Practice address
630-7 ATLANTIC BLVD., NEPTUNE BEACH, FL 32266
(904) 247-2626
(904) 247-2291
Mailing address
3545-1 ST. JOHNS BLUFF RD. S., SUITE 352, JACKSONVILLE, FL 32224
(904) 998-7000
(904) 998-7702
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
DN15716
FL
305S00000X
Point of Service
DN15716
FL
Other
Enumeration date
08/27/2013
Last updated
01/23/2015
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