Healthcare Provider Details

I. General information

NPI: 1962411876
Provider Name (Legal Business Name): FRANK MARCUS GUPTON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86207 FELMOR RD
YULEE FL
32097-5303
US

IV. Provider business mailing address

PO BOX 517
FERNANDINA BEACH FL
32035-0517
US

V. Phone/Fax

Practice location:
  • Phone: 904-548-1849
  • Fax: 904-225-8520
Mailing address:
  • Phone: 904-548-1800
  • Fax: 904-277-7286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDN14307
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: