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General NPI Number Information
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NPI Number | 1508051228
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Entity Type | Organization
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Legal Business Name | WEST THIRD DENTAL CARE CENTER
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Dates
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Enumeration Date | 09/06/2007
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Last Update Date | 09/06/2007
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Provider Practice Location Address
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Address Line | 235 W 3RD STREET
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City | JACKSONVILLE
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State | FL
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Zip | 32206-4910
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Country | US
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Telephone | 904-356-0243
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Fax | 904-356-0602
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Provider Business Mailing Address
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Address Line | 235 W 3RD STREET
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City | JACKSONVILLE
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State | FL
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Zip | 32206-4910
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Country | US
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Telephone | 904-646-3089
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Fax | 904-356-0602
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLIAM M FLEISCHMANN
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Credential | DDS
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Telephone | 904-356-0243
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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 | DN005701
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License Number State | FL
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