904 Implants And Dentures PLLC
Clinic/Center, Dental in Jacksonville, FL. Organization (NPI-2).
NPI number1700549136
StatusActive
Last updated in NPPESOct 21, 2021
Details
- NPI
- 1700549136
- Entity type
- Organization (NPI-2)
- Legal business name
- 904 Implants And Dentures PLLC
- Organization subpart
- No
- Enumeration date
- Oct 21, 2021
- Certification date
- Oct 21, 2021
- Last updated
- Oct 21, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | – | – | Yes |
Practice location
11645 Beach Blvd Ste 101Jacksonville, FL 32246-8496
Phone 904-999-9000
Mailing address
11645 Beach Blvd Ste 101Jacksonville, FL 32246-8496
Phone 904-999-9000
Authorized official
William Russell
Co-Owner
8036656998
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