Healthcare Provider Details

I. General information

NPI: 1306853023
Provider Name (Legal Business Name): LINDA AUFDEMBRINK TROTTER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2532 OAK STREET
JACKSONVILLE FL
32204
US

IV. Provider business mailing address

2537 OAK STREET
JACKSONVILLE FL
32204
US

V. Phone/Fax

Practice location:
  • Phone: 904-389-3451
  • Fax: 904-389-8489
Mailing address:
  • Phone: 904-389-3451
  • Fax: 904-389-8489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number11386
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: