Organization
ADVANCED MAXILLOFACIAL SURGICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON LEE DDS (OWNER)
(904) 444-1578
Entity
Organization
Contact information
Practice address
3625 UNIVERSITY BLVD S, JACKSONVILLE, FL 32216-4207
(904) 702-6111
Mailing address
4257 POINT LA VISTA RD W, JACKSONVILLE, FL 32207-6247
(904) 703-2236
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DN18554
FL
Other
Enumeration date
07/09/2014
Last updated
01/07/2025
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