Organization
JACKSONVILLE TONGUE TIE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACEY VEAL (PRACTICE ADMINISTRATOR)
(904) 584-9004
Entity
Organization
Contact information
Practice address
196 EVEREST LN STE 1, SAINT JOHNS, FL 32259-4103
(904) 584-9004
Mailing address
196 EVEREST LN STE 1, SAINT JOHNS, FL 32259-4103
(904) 584-9004
(904) 347-2011
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
12/15/2021
Last updated
12/15/2021
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