Organization
PONCE DE LEON FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THEODORE DANIEL HAEUSSNER (DENTIST)
(904) 797-8247
Entity
Organization
Contact information
Practice address
4 SAINT JOHNS MEDICAL PK DR, SAINT AUGUSTINE, FL 32086-5298
(904) 797-9009
(904) 797-9057
Mailing address
4 SAINT JOHNS MEDICAL PK DR, SAINT AUGUSTINE, FL 32086-5298
(904) 797-9009
(904) 797-9057
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
07/03/2008
Last updated
07/03/2008
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