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General NPI Number Information
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NPI Number | 1407710387
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Entity Type | Organization
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Legal Business Name | EKOS GREEN COVE SPRINGS PLLC
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Dates
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Enumeration Date | 12/15/2025
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 1305 N ORANGE AVE
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City | GREEN COVE SPRINGS
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State | FL
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Zip | 32043-2547
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Country | US
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Telephone | 904-282-8752
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Fax |
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Provider Business Mailing Address
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Address Line | 8794 BOYNTON BEACH BLVD STE 218
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City | BOYNTON BEACH
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State | FL
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Zip | 33472-4469
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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 | TITLE MGR
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Name | SEAN TOMALTY
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Credential |
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Telephone | 561-789-6611
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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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