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General NPI Number Information
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NPI Number | 1205550977
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Entity Type | Organization
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Legal Business Name | SEABREEZE SURGICAL PLLC
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Dates
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Enumeration Date | 09/27/2022
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Last Update Date | 09/27/2022
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Provider Practice Location Address
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Address Line | 5117 J TURNER BUTLER BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32216-6080
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Country | US
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Telephone | 904-467-5268
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Fax |
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Provider Business Mailing Address
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Address Line | 5117 J TURNER BUTLER BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32216-6080
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MELISSA DENT
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Credential |
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Telephone | 904-537-1003
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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 |
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License Number State |
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Taxonomy #2
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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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