Healthcare Provider Details

I. General information

NPI: 1588871289
Provider Name (Legal Business Name): WILLIAM RAYMOND GIELINCKI JR. D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6855 BELFORT OAKS PL
JACKSONVILLE FL
32216-6242
US

IV. Provider business mailing address

6855 BELFORT OAKS PL
JACKSONVILLE FL
32216-6242
US

V. Phone/Fax

Practice location:
  • Phone: 904-281-0658
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDN 10052
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: