Healthcare Provider Details

I. General information

NPI: 1558285460
Provider Name (Legal Business Name): 360 DENTAL LOUNGE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 SAINT JOHNS PKWY STE 102
ST JOHNS FL
32259-2422
US

IV. Provider business mailing address

637 WATERVALE DR
SAINT AUGUSTINE FL
32092-1770
US

V. Phone/Fax

Practice location:
  • Phone: 904-671-7085
  • Fax: 904-671-7075
Mailing address:
  • Phone: 904-671-7085
  • Fax: 904-671-7075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. LINDSAY MORGAN
Title or Position: MANAGING MEMBER
Credential: DDS
Phone: 904-671-7085