Healthcare Provider Details

I. General information

NPI: 1881611796
Provider Name (Legal Business Name): KOK-TOW NG, DDS., PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4131 UNIVERSITY BLVD S STE 5
JACKSONVILLE FL
32216-4346
US

IV. Provider business mailing address

4131 UNIVERSITY BLVD S STE 5
JACKSONVILLE FL
32216-4346
US

V. Phone/Fax

Practice location:
  • Phone: 904-731-0521
  • Fax: 904-731-0518
Mailing address:
  • Phone: 904-731-0521
  • Fax: 904-731-0518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN 12185
License Number StateFL

VIII. Authorized Official

Name: DR. KOK-TOW NG
Title or Position: PRESIDENT
Credential: DDS
Phone: 904-731-0521