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General NPI Number Information
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NPI Number | 1538592852
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Entity Type | Organization
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Legal Business Name | PALM VALLEY FAMILY DENTISTRY, P.A.
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Dates
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Enumeration Date | 08/11/2013
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Last Update Date | 08/15/2013
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Provider Practice Location Address
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Address Line | 3791 PALM VALLEY RD SUITE 205
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City | PONTE VEDRA BEACH
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State | FL
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Zip | 32082-4182
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Country | US
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Telephone | 904-834-2736
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Fax | 904-834-2737
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Provider Business Mailing Address
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Address Line | 3791 PALM VALLEY RD SUITE 205
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City | PONTE VEDRA BEACH
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State | FL
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Zip | 32082-4182
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Country | US
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Telephone | 904-834-2736
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Fax | 904-834-2737
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID JAMES YODER
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Credential | DDS
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Telephone | 904-673-5869
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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 | DN19044
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License Number State | FL
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