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General NPI Number Information
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NPI Number | 1497548259
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Entity Type | Organization
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Legal Business Name | MILL COVE FAMILY DENTISTRY, LLC
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Dates
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Enumeration Date | 05/26/2025
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Last Update Date | 05/26/2025
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Provider Practice Location Address
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Address Line | 9119 MERRILL RD STE 29
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City | JACKSONVILLE
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State | FL
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Zip | 32225-4306
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Country | US
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Telephone | 904-549-9777
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Fax |
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Provider Business Mailing Address
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Address Line | 4530 ST JOHNS AVE STE 15 #225
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City | JACKSONVILLE
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State | FL
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Zip | 32210-1852
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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/DENTIST
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Name | DR. AUSTIN GROVENSTEIN
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Credential | DMD
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Telephone | 904-549-9777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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