Healthcare Provider Details

I. General information

NPI: 1205550977
Provider Name (Legal Business Name): SEABREEZE SURGICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2022
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5117 J TURNER BUTLER BLVD
JACKSONVILLE FL
32216-6080
US

IV. Provider business mailing address

5117 J TURNER BUTLER BLVD
JACKSONVILLE FL
32216-6080
US

V. Phone/Fax

Practice location:
  • Phone: 904-467-5268
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: MELISSA DENT
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 904-537-1003