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General NPI Number Information
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NPI Number | 1033804828
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Entity Type | Organization
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Legal Business Name | S REEDER HENLEY ORAL SURGERY
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Dates
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Enumeration Date | 04/07/2023
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Last Update Date | 06/21/2023
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Provider Practice Location Address
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Address Line | 4100 SOUTHPOINT DR E STE 5
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City | JACKSONVILLE
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State | FL
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Zip | 32216-8710
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Country | US
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Telephone | 904-281-2225
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Fax |
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Provider Business Mailing Address
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Address Line | 4100 SOUTHPOINT DR E STE 5
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City | JACKSONVILLE
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State | FL
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Zip | 32216-8710
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Country | US
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Telephone | 904-281-2225
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEPHANIE REEDER HENLEY
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Credential | DMD, MD
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Telephone | 352-318-8660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number |
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License Number State |
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