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General NPI Number Information
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NPI Number | 1083048011
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Entity Type | Organization
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Legal Business Name | GERALD K. WEAVER, D.M.D. AND MICHAEL STRATTON, D.M.D., PEDIATRIC DENTI
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Dates
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Enumeration Date | 08/27/2013
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 1584 KINGSLEY AVE STE B
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City | ORANGE PARK
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State | FL
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Zip | 32073-4502
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Country | US
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Telephone | 904-264-5437
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Fax | 904-485-8417
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Provider Business Mailing Address
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Address Line | 3030 HARTLEY RD STE 310
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City | JACKSONVILLE
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State | FL
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Zip | 32257-8213
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Country | US
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Telephone | 904-264-5437
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Fax | 904-485-8417
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Authorized Official
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Title or Position | INSURANCE MANAGER
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Name | KAREN BAUCOM
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Credential |
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Telephone | 904-264-5437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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