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General NPI Number Information
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NPI Number | 1790500908
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Entity Type | Organization
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Legal Business Name | PALM VALLEY FAMILY DENTISTRY, PLLC
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Dates
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Enumeration Date | 11/21/2024
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 3791 PALM VALLEY RD STE 205
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City | PONTE VEDRA BEACH
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State | FL
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Zip | 32082-4180
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Country | US
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Telephone | 904-834-2736
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Fax |
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Provider Business Mailing Address
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Address Line | 3791 PALM VALLEY RD STE 205
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City | PONTE VEDRA BEACH
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State | FL
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Zip | 32082-4180
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Country | US
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Telephone | 904-834-2736
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MCKENZIE WORTEN
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Credential |
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Telephone | 904-834-2736
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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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