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General NPI Number Information
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NPI Number | 1528618071
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Entity Type | Organization
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Legal Business Name | BEACHVIEW DENTAL PLLC
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Dates
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Enumeration Date | 09/17/2019
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Last Update Date | 09/17/2019
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Provider Practice Location Address
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Address Line | 1700 WELLS RD STE 19
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City | ORANGE PARK
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State | FL
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Zip | 32073-2374
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Country | US
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Telephone | 904-586-1234
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 WELLS RD STE 19
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City | ORANGE PARK
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State | FL
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Zip | 32073-2374
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Country | US
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Telephone | 904-586-1234
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL JAMES THOMASINO
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Credential | DMD
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Telephone | 904-586-1234
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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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