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General NPI Number Information
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NPI Number | 1538423413
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Entity Type | Organization
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Legal Business Name | JEFFREY S. PRIETO, DDS
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Dates
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Enumeration Date | 06/26/2012
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Last Update Date | 06/26/2012
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Provider Practice Location Address
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Address Line | 1950 MILLER ST 3
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City | ORANGE PARK
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State | FL
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Zip | 32073-4759
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Country | US
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Telephone | 904-269-3488
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Fax | 904-278-0931
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Provider Business Mailing Address
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Address Line | 1950 MILLER ST 3
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City | ORANGE PARK
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State | FL
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Zip | 32073-4759
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Country | US
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Telephone | 904-269-3488
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Fax | 904-278-0931
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Authorized Official
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Title or Position | MANAGER
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Name | OVOILETTE E HOLT
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Credential |
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Telephone | 904-269-3488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | DN-14358
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License Number State | FL
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