Organization
LARRY D. BURNSIDE D.D.S.,P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARRY DAVID BURNSIDE DDS (PRESIDENT)
(904) 268-0904
Entity
Organization
Contact information
Practice address
12708 SAN JOSE BLVD, JACKSONVILLE, FL 32223-2689
(904) 268-0904
(904) 268-0306
Mailing address
711 CREIGHTON RD, ORANGE PARK, FL 32003-7008
(904) 264-2759
(904) 268-0306
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
7825
FL
Other
Enumeration date
11/10/2006
Last updated
08/22/2020
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