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General NPI Number Information
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NPI Number | 1194831230
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Entity Type | Organization
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Legal Business Name | JULINGTON CREEK FAMILY DENTISTRY, PA
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 465 STATE ROAD 13 STE 9
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City | JACKSONVILLE
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State | FL
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Zip | 32259-3858
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Country | US
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Telephone | 904-230-2931
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Fax | 904-230-1627
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Provider Business Mailing Address
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Address Line | 465 STATE ROAD 13 STE 9
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City | JACKSONVILLE
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State | FL
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Zip | 32259-3858
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Country | US
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Telephone | 904-230-2931
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Fax | 904-230-1627
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SUSAN LYNN AMATRUDI
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Credential | DMD
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Telephone | 904-230-2961
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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 | DN13430
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License Number State | FL
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