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General NPI Number Information
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NPI Number | 1619910148
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Entity Type | Individual
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Provider Name | STEVEN J UNDERKOFLER D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1746 UNIVERSITY BLVD S
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City | JACKSONVILLE
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State | FL
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Zip | 32216-8929
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Country | US
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Telephone | 904-724-3023
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Fax |
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Provider Business Mailing Address
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Address Line | 10753 WAVERLY BLUFF WAY
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City | JACKSONVILLE
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State | FL
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Zip | 32223-6681
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Country | US
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Telephone | 904-262-1262
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN0010658
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License Number State | FL
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