| Haeussner Dental Group | |
|
1409 Kingsley Ave Bldg. #11 Orange Park FL 32073-4562 | |
| (904) 264-2483 | |
| (904) 264-0474 |
| Full Name | Haeussner Dental Group |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1409 Kingsley Ave, Orange Park, Florida |
| Authorized Official Name and Position | Theodore Adrian Haeussner (PRESIDENT) |
| Authorized Official Contact | 9042642483 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Haeussner Dental Group 1409 Kingsley Ave Bldg. #11 Orange Park FL 32073-4562 Ph: (904) 264-2483 | Haeussner Dental Group 1409 Kingsley Ave Bldg. #11 Orange Park FL 32073-4562 Ph: (904) 264-2483 |
| NPI Number | 1174642375 |
|---|---|
| Provider Enumeration Date | 03/28/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174642375 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DN 6384 (Florida) | Primary |
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