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General NPI Number Information
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NPI Number | 1821423617
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Entity Type | Organization
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Legal Business Name | KIDS FIRST DENTISTRY,INC
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Dates
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Enumeration Date | 09/11/2013
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Last Update Date | 09/11/2013
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Provider Practice Location Address
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Address Line | 4495 ROOSEVELT BLVD SUITE 111
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City | JACKSONVILLE
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State | FL
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Zip | 32210-3375
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Country | US
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Telephone | 904-423-1377
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Fax | 904-423-1958
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Provider Business Mailing Address
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Address Line | 4495 ROOSEVELT BLVD SUITE 111
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City | JACKSONVILLE
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State | FL
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Zip | 32210-3375
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Country | US
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Telephone | 904-423-1377
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Fax | 904-423-1958
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Authorized Official
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Title or Position | CEO
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Name | DR. JILA J MAHAJAN
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Credential | DDS
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Telephone | 904-423-1377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN13919
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License Number State | FL
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