MEDICARE: LITTLE LOVE PEDIATRIC DENTISTRY AND WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1003612730
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITTLE LOVE PEDIATRIC DENTISTRY AND WELLNESS

Provider Business Mailing Address
First Line	:	628 SOUTHERN OAK DR
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32081-8368
Country	:	US
Telephone Number	:	904-206-8809
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 SILVER FOREST DR STE 108
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32092-3836
Country	:	US
Telephone Number	:	904-206-8809
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AMBER SUN
Credential	:
Telephone Number	:	404-578-5247

Provider Enumeration Date	:	02/24/2025
Last Update Date	:	02/24/2025

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Directions to “LITTLE LOVE PEDIATRIC DENTISTRY AND WELLNESS ” Practice Location

Language	Start Address	Practice Location

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