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General NPI Number Information
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NPI Number | 1588512511
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Entity Type | Organization
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Legal Business Name | THE JESUS CLINIC INC
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Dates
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Enumeration Date | 03/17/2026
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Last Update Date | 03/17/2026
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Provider Practice Location Address
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Address Line | 1630 MASON AVE STE A
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-4503
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Country | US
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Telephone | 386-253-6959
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Fax | 386-253-6957
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Provider Business Mailing Address
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Address Line | 1630 MASON AVE STE A
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-4503
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Country | US
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Telephone | 386-253-6959
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Fax | 386-253-6957
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. JEFF RUNDALL
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Credential |
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Telephone | 386-576-7076
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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 |
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License Number State |
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