Healthcare Provider Details

I. General information

NPI: 1356351654
Provider Name (Legal Business Name): DAVID RANDALL CARDEN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 3RD ST S
JACKSONVILLE BEACH FL
32250-6062
US

IV. Provider business mailing address

3540 3RD ST S
JACKSONVILLE BEACH FL
32250-6062
US

V. Phone/Fax

Practice location:
  • Phone: 904-241-2471
  • Fax: 904-241-5673
Mailing address:
  • Phone: 904-241-2471
  • Fax: 904-241-5673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number7217
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: