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General NPI Number Information
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NPI Number | 1245472802
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Entity Type | Individual
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Provider Name | ANDREW WILLIAM MAPLES D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/28/2009
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Last Update Date | 08/17/2010
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Provider Practice Location Address
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Address Line | 1061 RIVERSIDE AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32204-4152
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Country | US
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Telephone | 904-355-5531
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Fax |
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Provider Business Mailing Address
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Address Line | 9734 TAPESTRY PARK CIR APT. #387
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City | JACKSONVILLE
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State | FL
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Zip | 32246-9906
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Country | US
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Telephone | 904-234-9583
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 6350-015
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License Number State | WI
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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 | DN 18277
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License Number State | FL
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