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General NPI Number Information
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NPI Number | 1407630148
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Entity Type | Organization
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Legal Business Name | SOH OF FLORIDA PA
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Dates
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Enumeration Date | 08/23/2023
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 1584 KINGSLEY AVE STE A
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City | ORANGE PARK
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State | FL
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Zip | 32073-4515
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Country | US
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Telephone | 904-990-0926
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Fax |
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Provider Business Mailing Address
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Address Line | 1584 KINGSLEY AVE STE A
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City | ORANGE PARK
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State | FL
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Zip | 32073-4515
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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 | CREDENTIALING SPECIALIST
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Name | ASHLY SUNSHINE
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Credential |
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Telephone | 314-413-2803
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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