Healthcare Provider Details

I. General information

NPI: 1821184565
Provider Name (Legal Business Name): RAMSEY BADER SALEM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6237 MERRILL ROAD
JACKSONVILLE FL
32277
US

IV. Provider business mailing address

638 QUEENS HARBOUR BLVD
JACKSONVILLE FL
32225-4928
US

V. Phone/Fax

Practice location:
  • Phone: 904-744-2111
  • Fax: 904-743-0035
Mailing address:
  • Phone: 904-221-0892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number007782
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: