Healthcare Provider Details

I. General information

NPI: 1073563110
Provider Name (Legal Business Name): JAMES GREGORY DENT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 06/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 HEALTH PARK BLVD
ST AUGUSTINE FL
32086-5784
US

IV. Provider business mailing address

400 HEALTH PARK BLVD
ST AUGUSTINE FL
32086-5784
US

V. Phone/Fax

Practice location:
  • Phone: 904-819-4565
  • Fax: 904-819-4999
Mailing address:
  • Phone: 904-819-4565
  • Fax: 904-819-4999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME71168
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: