Individual
ISIL ARAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2800 UNIVERSITY BLVD N, JACKSONVILLE, FL 32211-3394
(904) 256-7854
(904) 256-7798
Mailing address
2800 UNIVERSITY BLVD N, JACKSONVILLE, FL 32211-3394
(904) 256-7854
(904) 256-7798
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DTP678
FL
Other
Enumeration date
02/04/2019
Last updated
02/04/2019
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