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General NPI Number Information
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NPI Number | 1225488232
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Entity Type | Organization
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Legal Business Name | AVENUES DENTAL LLC
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Dates
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Enumeration Date | 06/21/2016
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Last Update Date | 06/21/2016
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Provider Practice Location Address
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Address Line | 6144 GAZEBO PARK PLACE SOUTH STE 210
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City | JACKSONVILLE
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State | FL
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Zip | 32257
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Country | US
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Telephone | 904-262-9466
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Fax |
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Provider Business Mailing Address
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Address Line | 3068 BRETTUNGAR 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 | 954-551-4624
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. JIGNESH PATEL
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Credential | DMD
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Telephone | 954-551-4624
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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 | DN 19907
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License Number State | FL
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