MEDICARE: DR. ERIC L TOWNSEND DDS

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	1223G0001X	General Practice Dentistry	DN10655	FL

General Provider Information

NPI Number	:	1306849336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC L TOWNSEND DDS

Provider Business Mailing Address
First Line	:	105 SOLANA RD
Second Line	:	STE A
City	:	PONTE VEDRA
State	:	FL
Zip	:	32082-5229
Country	:	US
Telephone Number	:	904-285-7711
Fax Number	:	904-285-3604

Provider Business Practice Location Address
First Line	:	105 SOLANA RD
Second Line	:	STE A
City	:	PONTE VEDRA
State	:	FL
Zip	:	32082-5229
Country	:	US
Telephone Number	:	904-285-7711
Fax Number	:	904-285-3604

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	07/08/2007

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