Healthcare Provider Details

I. General information

NPI: 1568900785
Provider Name (Legal Business Name): AD34 FLORIDA P.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2017
Last Update Date: 02/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2896 S 8TH ST
FERNANDINA BEACH FL
32034-4462
US

IV. Provider business mailing address

401 COMMERCE DR SUITE 108
FORT WASHINGTON PA
19034-2714
US

V. Phone/Fax

Practice location:
  • Phone: 904-261-6826
  • Fax:
Mailing address:
  • Phone: 215-550-4590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREW DORMESHIAN
Title or Position: OWNER
Credential:
Phone: 917-847-6976