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General NPI Number Information
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NPI Number | 1215370788
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Entity Type | Organization
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Legal Business Name | SAN MARCO DENTISTRY
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Dates
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Enumeration Date | 04/15/2013
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Last Update Date | 08/18/2016
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Provider Practice Location Address
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Address Line | 1925 HENDRICKS AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32207-3305
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Country | US
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Telephone | 904-398-1247
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Fax | 904-398-8647
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Provider Business Mailing Address
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Address Line | 1925 HENDRICKS AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32207-3305
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Country | US
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Telephone | 904-398-1247
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Fax | 904-398-8647
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN F HOWARD JR.
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Credential | DDS
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Telephone | 904-398-1247
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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 | 19063
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License Number State | FL
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