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General NPI Number Information
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NPI Number | 1174876809
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Entity Type | Organization
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Legal Business Name | ASAP DENTAL CARE LLC
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Dates
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Enumeration Date | 10/18/2012
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Last Update Date | 10/18/2012
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Provider Practice Location Address
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Address Line | 7451-18 103RD STREET
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City | JACKSONVILLE
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State | FL
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Zip | 32210-7451
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Country | US
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Telephone | 904-777-4622
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Fax | 904-777-4685
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Provider Business Mailing Address
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Address Line | 7451-18 103RD STREET
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City | JACKSONVILLE
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State | FL
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Zip | 32210
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Country | US
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Telephone | 904-777-4622
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Fax | 904-777-4685
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Authorized Official
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Title or Position | OWEN
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Name | TIM TURSONOV
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Credential |
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Telephone | 904-777-4622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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