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General NPI Number Information
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NPI Number | 1003249467
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Entity Type | Organization
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Legal Business Name | FIRST COAST DENTISTRY, P.A.
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Dates
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Enumeration Date | 08/20/2013
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Last Update Date | 08/20/2013
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Provider Practice Location Address
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Address Line | 320 3RD ST STE A
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City | NEPTUNE BEACH
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State | FL
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Zip | 32266-5100
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Country | US
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Telephone | 904-249-3739
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Fax | 904-249-7811
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Provider Business Mailing Address
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Address Line | 320 3RD ST STE A
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City | NEPTUNE BEACH
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State | FL
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Zip | 32266-5100
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Country | US
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Telephone | 904-249-3739
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Fax | 904-249-7811
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Authorized Official
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Title or Position | DENTIST
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Name | DR. TIMOTHY JOHN TOMAN
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Credential | D.M.D.
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Telephone | 904-249-3739
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN16225
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License Number State | FL
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