Healthcare Provider Details

I. General information

NPI: 1992622831
Provider Name (Legal Business Name): INSTITUTE OF ORAL IMPLANTOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11251 NETWORK DRIVE
JACKSONVILLE FL
32256
US

IV. Provider business mailing address

PO BOX 50158
JACKSONVILLE BEACH FL
32240-0158
US

V. Phone/Fax

Practice location:
  • Phone: 813-732-3792
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ANTHONY CORRAL
Title or Position: CHIEF OPERATING OFFICER
Credential: DMD
Phone: 904-204-0304