| Modern Periodontics, Pa | |
|
1409 Kingsley Ave Suite 9a Orange Park FL 32073-4537 | |
| (904) 278-1175 | |
| Not Available |
| Full Name | Modern Periodontics, Pa |
|---|---|
| Speciality | Dentist |
| Location | 1409 Kingsley Ave, Orange Park, Florida |
| Authorized Official Name and Position | Angeline Ann Kuznia (DENTIST/OWNER) |
| Authorized Official Contact | 9042781175 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Modern Periodontics, Pa 1409 Kingsley Ave Suite 9a Orange Park FL 32073-4537 Ph: (904) 278-1175 | Modern Periodontics, Pa 1409 Kingsley Ave Suite 9a Orange Park FL 32073-4537 Ph: (904) 278-1175 |
| NPI Number | 1922428879 |
|---|---|
| Provider Enumeration Date | 04/18/2014 |
| Last Update Date | 04/18/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922428879 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DN15267 (Florida) | Primary |
| 122300000X | Dentist | DN17936 (Florida) | Secondary |
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