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General NPI Number Information
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NPI Number | 1609765205
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Entity Type | Organization
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Legal Business Name | WEST FLORIDA PERIODONTICS AND IMPLANT DENTISTRY, PLLC
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Dates
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Enumeration Date | 06/30/2025
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 6111 N DAVIS HWY STE B
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City | PENSACOLA
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State | FL
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Zip | 32504-6913
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Country | US
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Telephone | 850-476-8418
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Fax |
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Provider Business Mailing Address
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Address Line | 6111 N DAVIS HWY STE B
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City | PENSACOLA
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State | FL
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Zip | 32504-6913
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Country | US
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Telephone | 850-476-8418
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Fax |
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Authorized Official
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Title or Position | PERIODONTIST
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Name | MARY JOYCE
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Credential | DMD
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Telephone | 850-476-8418
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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