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General NPI Number Information
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NPI Number | 1205476496
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Entity Type | Organization
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Legal Business Name | POINT MEADOWS DENTAL CENTER, INC.
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Dates
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Enumeration Date | 01/15/2020
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Last Update Date | 01/15/2020
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Provider Practice Location Address
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Address Line | 10915 BAYMEADOWS RD, #106
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City | JACKSONVILLE
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State | FL
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Zip | 32256
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Country | US
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Telephone | 904-619-6478
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Fax |
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Provider Business Mailing Address
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Address Line | 2759 TARTUS DRIVE
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City | JACKSONVILLE
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State | FL
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Zip | 32246
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Country | US
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Telephone | 954-465-5114
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. JOHN WILLIAM BRADBERRY
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Credential |
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Telephone | 954-465-5114
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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 |
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License Number State |
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