Healthcare Provider Details

I. General information

NPI: 1225254220
Provider Name (Legal Business Name): KANEHL DENTAL GROUP, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7933 BAYMEADOWS WAY SUITE 5
JACKSONVILLE FL
32256-7564
US

IV. Provider business mailing address

7933 BAYMEADOWS WAY SUITE 5
JACKSONVILLE FL
32256-7564
US

V. Phone/Fax

Practice location:
  • Phone: 904-731-2162
  • Fax: 904-448-1403
Mailing address:
  • Phone: 904-731-2162
  • Fax: 904-448-1403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6854
License Number StateFL

VIII. Authorized Official

Name: DR. BRUCE ARTHUR KANEHL
Title or Position: OWNER
Credential: DMD
Phone: 904-731-2162