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General NPI Number Information
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NPI Number | 1518699826
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Entity Type | Organization
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Legal Business Name | BEACHWALK DENTAL, PA
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Dates
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Enumeration Date | 06/27/2022
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Last Update Date | 06/27/2022
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Provider Practice Location Address
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Address Line | 855 COUNTY ROAD 210 WEST SUITE A2 AND A3
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City | ST. AUGUSTINE
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State | FL
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Zip | 32259
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Country | US
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Telephone | 904-549-9045
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Fax |
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Provider Business Mailing Address
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Address Line | 2801 SAINT JOHNS BLUFF RD S STE 101
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City | JACKSONVILLE
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State | FL
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Zip | 32246-3862
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Country | US
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Telephone | 904-998-7000
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Fax |
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Authorized Official
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Title or Position | GENERAL COUNSEL
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Name | JESSICA NARDUCCI
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Credential |
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Telephone | 904-626-6023
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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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