Organization
DENTAL PLACE OF JAX
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE M BUNCH D.D.S. (OWNER)
(904) 563-3589
Entity
Organization
Contact information
Practice address
5800 BEACH BLVD, #A102, JACKSONVILLE, FL 32207-5120
(904) 860-3765
Mailing address
5800 BEACH BLVD, #A102, JACKSONVILLE, FL 32207-5120
(904) 860-3765
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN17326
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
76637200
—
FL
Enumeration date
07/15/2013
Last updated
07/15/2013
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