| The Village Dentist | |
|
425 W Town Pl Suite 106 St Augustine FL 32092-3661 | |
| (904) 940-7990 | |
| (904) 940-7991 |
| Full Name | The Village Dentist |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 425 W Town Pl, St Augustine, Florida |
| Authorized Official Name and Position | Michele Gibson (OFFICE MANAGER) |
| Authorized Official Contact | 9049407990 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Village Dentist 425 W Town Pl Suite 106 St Augustine FL 32092-3661 Ph: (904) 940-7990 | The Village Dentist 425 W Town Pl Suite 106 St Augustine FL 32092-3661 Ph: (904) 940-7990 |
| NPI Number | 1205132503 |
|---|---|
| Provider Enumeration Date | 02/03/2011 |
| Last Update Date | 02/03/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205132503 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DN11714 (Florida) | Primary |
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