=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518388545
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SWITZERLAND DENTAL INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/17/2013
-----------------------------------------------------
Last Update Date | 07/30/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1820 STATE ROAD 13 SUITE 8
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32259-8856
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-230-4567
-----------------------------------------------------
Fax | 904-230-4604
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1820 STATE ROAD 13 SUITE 8
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32259-8856
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-230-4567
-----------------------------------------------------
Fax | 904-230-4604
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP
-----------------------------------------------------
Name | DR. MARY SHAEFFER
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 904-230-4567
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DN16384
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DN16623
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------