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General NPI Number Information
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NPI Number | 1861723777
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Entity Type | Organization
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Legal Business Name | BOB W. DEASON, DDS, PA
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Dates
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Enumeration Date | 01/18/2010
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Last Update Date | 01/18/2010
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Provider Practice Location Address
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Address Line | 765 MILL CREEK RD
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City | JACKSONVILLE
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State | FL
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Zip | 32211-6432
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Country | US
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Telephone | 904-724-6321
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Fax | 904-721-6151
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Provider Business Mailing Address
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Address Line | 765 MILL CREEK RD
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City | JACKSONVILLE
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State | FL
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Zip | 32211-6432
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Country | US
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Telephone | 904-724-6321
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Fax | 904-721-6151
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. BOB DEASON
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Credential | DDS
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Telephone | 904-724-6321
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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 | DN6332
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License Number State | FL
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