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General NPI Number Information
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NPI Number | 1356253199
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Entity Type | Organization
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Legal Business Name | ORAL AND MAXILLOFACIAL SURGERY OF JACKSONVILLE, PLLC
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Dates
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Enumeration Date | 09/17/2026
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Last Update Date | 09/17/2026
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Provider Practice Location Address
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Address Line | 95 JAIDEV ROAD BLDG 10, SUITE101
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City | ST. JOHNS
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State | FL
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Zip | 32259-1140
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Country | US
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Telephone | 904-820-8956
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Fax | 904-820-8957
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Provider Business Mailing Address
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Address Line | 95 JAIDEV ROAD BLDG 10, SUITE101
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City | ST. JOHNS
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State | FL
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Zip | 32259-1140
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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 | OWNER
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Name | VINCENT PERCIACCANTE
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Credential |
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Telephone | 904-820-8956
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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