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60 Shops Blvd Ste 10 Saint Johns FL 32259-2385 | |
| (904) 637-1867 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 60 Shops Blvd Ste 10, Saint Johns, Florida |
| Authorized Official Name and Position | Jessica Britt (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 2175405100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
60 Shops Blvd Ste 10 Saint Johns FL 32259-2385 Ph: (904) 506-0156 | 60 Shops Blvd Ste 10 Saint Johns FL 32259-2385 Ph: (904) 637-1867 |
| NPI Number | 1316583446 |
|---|---|
| Provider Enumeration Date | 11/25/2019 |
| Last Update Date | 02/10/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316583446 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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