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General NPI Number Information
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NPI Number | 1184802522
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Entity Type | Organization
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Legal Business Name | ALACHUA FAMILY DENTISTRY
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Dates
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Enumeration Date | 02/07/2008
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Last Update Date | 02/07/2008
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Provider Practice Location Address
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Address Line | 14690 NW 151ST BLVD UNIT 20
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City | ALACHUA
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State | FL
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Zip | 32615
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Country | US
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Telephone | 386-462-1771
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Fax |
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Provider Business Mailing Address
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Address Line | 2441 WINCHESTER LN
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City | ST AUGUSTINE
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State | FL
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Zip | 32092-1088
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Country | US
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Telephone | 386-462-1771
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CODY SCOTT GOSLINGA
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Credential | D.M.D.
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Telephone | 386-462-1771
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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 | 17072
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License Number State | FL
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