| Ponce De Leon Family Dentistry | |
|
4 Saint Johns Medical Pk Dr Saint Augustine FL 32086-5298 | |
| (904) 797-9009 | |
| (904) 797-9057 |
| Full Name | Ponce De Leon Family Dentistry |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 4 Saint Johns Medical Pk Dr, Saint Augustine, Florida |
| Authorized Official Name and Position | Theodore Daniel Haeussner (DENTIST) |
| Authorized Official Contact | 9047978247 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ponce De Leon Family Dentistry 4 Saint Johns Medical Pk Dr Saint Augustine FL 32086-5298 Ph: (904) 797-9009 | Ponce De Leon Family Dentistry 4 Saint Johns Medical Pk Dr Saint Augustine FL 32086-5298 Ph: (904) 797-9009 |
| NPI Number | 1801059480 |
|---|---|
| Provider Enumeration Date | 07/03/2008 |
| Last Update Date | 07/03/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801059480 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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