Healthcare Provider Details

I. General information

NPI: 1083048011
Provider Name (Legal Business Name): GERALD K. WEAVER, D.M.D. AND MICHAEL STRATTON, D.M.D., PEDIATRIC DENTI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2013
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1584 KINGSLEY AVE STE B
ORANGE PARK FL
32073-4502
US

IV. Provider business mailing address

3030 HARTLEY RD STE 310
JACKSONVILLE FL
32257-8213
US

V. Phone/Fax

Practice location:
  • Phone: 904-264-5437
  • Fax: 904-485-8417
Mailing address:
  • Phone: 904-264-5437
  • Fax: 904-485-8417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: KAREN BAUCOM
Title or Position: INSURANCE MANAGER
Credential:
Phone: 904-264-5437