| Guided Smiles Prosthodontics & Implant Center Pllc | |
|
153 Fort Wade Road Ste 100 Ponte Vedra FL 32081 | |
| (904) 395-5501 | |
| Not Available |
| Full Name | Guided Smiles Prosthodontics & Implant Center Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 153 Fort Wade Road, Ponte Vedra, Florida |
| Authorized Official Name and Position | Alonzo Carlos Blackmon (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 9043955501 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Guided Smiles Prosthodontics & Implant Center Pllc 153 Fort Wade Road Ste 100 Ponte Vedra FL 32081 Ph: () - | Guided Smiles Prosthodontics & Implant Center Pllc 153 Fort Wade Road Ste 100 Ponte Vedra FL 32081 Ph: (904) 395-5501 |
| NPI Number | 1114641339 |
|---|---|
| Provider Enumeration Date | 09/30/2022 |
| Last Update Date | 09/30/2022 |
| Medicare PECOS PAC ID | 5496127888 |
|---|---|
| Medicare Enrollment ID | O20230213000895 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114641339 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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