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General NPI Number Information
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NPI Number | 1225317423
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Entity Type | Organization
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Legal Business Name | ECONOMY DENTISTRY FOR CHILDREN CHILDREN'S GENERAL DENTISTRY , LLC
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Dates
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Enumeration Date | 08/05/2011
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Last Update Date | 11/14/2012
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Provider Practice Location Address
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Address Line | 1680 DUNN AVE #31
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City | JACKSONVILLE
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State | FL
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Zip | 32218-4782
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Country | US
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Telephone | 904-714-6939
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Fax | 904-751-9196
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Provider Business Mailing Address
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Address Line | 1680 DUNN AVE #31
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City | JACKSONVILLE
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State | FL
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Zip | 32218-4782
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Country | US
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Telephone | 904-696-6767
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Fax | 904-696-6833
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. LEROY R POLITE
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Credential | DMD
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Telephone | 904-714-6939
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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 | DN8243
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License Number State | FL
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