| Professional Dental Alliance Of St. Augustine, Pllc | |
|
2225 A1a S Ste A3 St Augustine FL 32080-6374 | |
| (904) 201-3442 | |
| Not Available |
| Full Name | Professional Dental Alliance Of St. Augustine, Pllc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2225 A1a S Ste A3, St Augustine, Florida |
| Authorized Official Name and Position | Lauren Howard (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 7575765479 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Professional Dental Alliance Of St. Augustine, Pllc 11 S Mill St Ste 200 New Castle PA 16101-3680 Ph: () - | Professional Dental Alliance Of St. Augustine, Pllc 2225 A1a S Ste A3 St Augustine FL 32080-6374 Ph: (904) 201-3442 |
| NPI Number | 1386294072 |
|---|---|
| Provider Enumeration Date | 09/16/2019 |
| Last Update Date | 09/16/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386294072 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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