Healthcare Provider Details

I. General information

NPI: 1497698708
Provider Name (Legal Business Name): VANESSA MONICA BLANCO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 NAUTICA DR UNIT 1
JACKSONVILLE FL
32218-7222
US

IV. Provider business mailing address

651 NAUTICA DR UNIT 1
JACKSONVILLE FL
32218-7222
US

V. Phone/Fax

Practice location:
  • Phone: 904-423-4014
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN31892
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: