Healthcare Provider Details

I. General information

NPI: 1891599965
Provider Name (Legal Business Name): NLD SPECIALISTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7885 NORMANDY BLVD
JACKSONVILLE FL
32221-6640
US

IV. Provider business mailing address

2845 UNIVERSITY BLVD W
JACKSONVILLE FL
32217-2116
US

V. Phone/Fax

Practice location:
  • Phone: 904-783-1633
  • Fax:
Mailing address:
  • Phone: 786-252-2617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH KING LEE
Title or Position: MEMBER
Credential: DMD
Phone: 786-252-2617