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General NPI Number Information
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NPI Number | 1265756571
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Entity Type | Organization
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Legal Business Name | DENTAL SPECIALISTS OF NORTH FLORIDA LLC
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Dates
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Enumeration Date | 03/16/2010
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Last Update Date | 03/16/2010
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Provider Practice Location Address
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Address Line | 3 CYPRESS BRANCH WAY SUITE C
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City | PALM COAST
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State | FL
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Zip | 32164-8409
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Country | US
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Telephone | 386-445-4242
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Fax | 386-445-4247
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Provider Business Mailing Address
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Address Line | 3 CYPRESS BRANCH WAY SUITE C
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City | PALM COAST
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State | FL
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Zip | 32164-8409
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Country | US
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Telephone | 386-445-4242
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Fax | 386-445-4247
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Authorized Official
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Title or Position | OWNER/PERIODONTIST
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Name | DR. ROBERT ROY THOUSAND JR.
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Credential | D.D.S.
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Telephone | 386-445-4242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DN7967
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License Number State | FL
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