Healthcare Provider Details

I. General information

NPI: 1326229329
Provider Name (Legal Business Name): JERRY A CIOFFI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: GERALD A CIOFFI DMD

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

767 BLANDING BLVD SUITE 108
ORANGE PARK FL
32065-8721
US

IV. Provider business mailing address

767 BLANDING BLVD SUITE 108
ORANGE PARK FL
32065
US

V. Phone/Fax

Practice location:
  • Phone: 904-272-6244
  • Fax: 904-276-0038
Mailing address:
  • Phone: 904-272-6244
  • Fax: 904-276-0038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN 11577
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: