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General NPI Number Information
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NPI Number | 1326603176
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Entity Type | Organization
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Legal Business Name | EVENS FAMILY DENTAL
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Dates
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Enumeration Date | 05/07/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 13107 ATLANTIC BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32225-7127
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Country | US
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Telephone | 904-683-6057
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Fax |
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Provider Business Mailing Address
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Address Line | 13107 ATLANTIC BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32225-7127
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | JENNIFER A. EVENS
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Credential |
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Telephone | 904-683-6057
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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 |
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License Number State |
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