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General NPI Number Information
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NPI Number | 1619693363
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Entity Type | Organization
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Legal Business Name | RIVERTOWN DENTAL PA
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Dates
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Enumeration Date | 10/14/2022
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Last Update Date | 10/14/2022
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Provider Practice Location Address
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Address Line | 205 RIVERTOWN SHOPS DR STE 104
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City | ST JOHNS
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State | FL
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Zip | 32259-7476
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Country | US
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Telephone | 904-901-0006
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Fax |
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Provider Business Mailing Address
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Address Line | 2801 SAINT JOHNS BLUFF RD S
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City | JACKSONVILLE
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State | FL
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Zip | 32246-3761
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Country | US
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Telephone | 904-998-7000
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NICHOLAS NARDUCCI
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Credential |
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Telephone | 904-998-7000
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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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