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General NPI Number Information
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NPI Number | 1164801825
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Entity Type | Organization
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Legal Business Name | BEACHSIDE ORAL SURGERY AND IMPLANTS LLC
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Dates
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Enumeration Date | 05/27/2015
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Last Update Date | 05/27/2015
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Provider Practice Location Address
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Address Line | 205 E EAU GALLIE BLVD 257
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City | INDIAN HARBOUR BEACH
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State | FL
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Zip | 32937-4873
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Country | US
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Telephone | 321-473-8247
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Fax |
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Provider Business Mailing Address
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Address Line | 205 E EAUGALLE BLVD 257
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City | INDIAN HARBOURE BEACH
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State | FL
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Zip | 32937
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Country | US
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Telephone | 321-473-8247
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Fax |
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Authorized Official
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Title or Position | EMPLOYEE
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Name | MRS. JAYANTHI CHOPRA
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Credential | DDS
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Telephone | 321-473-8247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 18935
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License Number State | FL
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