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General NPI Number Information
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NPI Number | 1497560023
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Entity Type | Organization
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Legal Business Name | PONTE VEDRA ORTHODONTICS LLC
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Dates
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Enumeration Date | 02/11/2025
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 3109 SAWGRASS VILLAGE CIR
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City | PONTE VEDRA BEACH
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State | FL
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Zip | 32082-5032
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Country | US
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Telephone | 904-273-9115
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Fax | 904-871-8116
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Provider Business Mailing Address
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Address Line | 3109 SAWGRASS VILLAGE CIR
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City | PONTE VEDRA BEACH
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State | FL
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Zip | 32082-5032
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Country | US
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Telephone | 904-273-9115
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Fax | 904-871-8116
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MERRIAN REFUERZO
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Credential |
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Telephone | 321-609-7241
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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