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General NPI Number Information
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NPI Number | 1336920016
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Entity Type | Organization
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Legal Business Name | DOVETAIL ORTHOPEDICS, LLC
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Dates
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Enumeration Date | 10/10/2023
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Last Update Date | 10/10/2023
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Provider Practice Location Address
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Address Line | 2416 LYNNDALE RD STE 102
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-5201
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Country | US
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Telephone | 904-430-7132
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Fax | 904-601-1512
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Provider Business Mailing Address
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Address Line | 2416 LYNNDALE RD STE 102
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-5201
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Country | US
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Telephone | 904-430-7132
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Fax | 904-601-1512
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT D. SANTROCK
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Credential | M.D.
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Telephone | 304-216-7960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0004X
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Taxonomy Name | Orthopaedic Foot and Ankle Surgery Physician
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License Number |
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License Number State |
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