Organization
CARLSON DENTAL GROUP RIVERSIDE, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BARBARA KAUFFMAN (OFFICE MANAGER)
(904) 262-8409
Entity
Organization
Contact information
Practice address
501 RIVERSIDE AVE, SUITE 104, JACKSONVILLE, FL 32202-4934
(904) 262-8409
(904) 262-4012
Mailing address
13241 BARTRAM PARK BLVD, BLDG 1700, JACKSONVILLE, FL 32258-5212
(904) 262-8409
(904) 262-4012
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
10002
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10002
DENTAL LICENSE NUMBER
FL
Enumeration date
04/22/2015
Last updated
04/22/2015
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