| Jacksonville Tongue Tie Llc | |
|
196 Everest Ln Ste 1 Saint Johns FL 32259-4103 | |
| (904) 584-9004 | |
| Not Available |
| Full Name | Jacksonville Tongue Tie Llc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 196 Everest Ln Ste 1, Saint Johns, Florida |
| Authorized Official Name and Position | Stacey Veal (PRACTICE ADMINISTRATOR) |
| Authorized Official Contact | 9045849004 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jacksonville Tongue Tie Llc 196 Everest Ln Ste 1 Saint Johns FL 32259-4103 Ph: (904) 584-9004 | Jacksonville Tongue Tie Llc 196 Everest Ln Ste 1 Saint Johns FL 32259-4103 Ph: (904) 584-9004 |
| NPI Number | 1831858067 |
|---|---|
| Provider Enumeration Date | 12/15/2021 |
| Last Update Date | 12/15/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831858067 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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