Organization
FLORIDA PERIODONTAL SPECIALISTS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER HERITAGE (CREDENTIALING MANAGER)
(402) 805-4516
Entity
Organization
Contact information
Practice address
12161 COUNTY ROAD 103 STE 101, OXFORD, FL 34484-2986
(352) 259-6799
Mailing address
12161 COUNTY ROAD 103 STE 101, OXFORD, FL 34484-2986
(352) 259-6799
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
Other
Enumeration date
02/25/2026
Last updated
02/25/2026
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