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General NPI Number Information
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NPI Number | 1861814063
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Entity Type | Organization
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Legal Business Name | PRIME CARE DENTAL CENTER,PA
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Dates
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Enumeration Date | 01/08/2014
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Last Update Date | 01/08/2014
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Provider Practice Location Address
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Address Line | 1555 KINGSLEY AVE SUITE 306
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City | ORANGE PARK
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State | FL
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Zip | 32073-4560
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Country | US
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Telephone | 904-215-2199
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Fax | 904-215-2188
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Provider Business Mailing Address
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Address Line | 1555 KINGSLEY AVENUE SUITE 306
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City | ORANGE PARK
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State | FL
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Zip | 32073-9203
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Country | US
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Telephone | 904-215-2199
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Fax | 904-215-2188
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARY ROSE A ALON-ALON
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Credential | DDS
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Telephone | 904-215-2199
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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 | 14708
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License Number State | FL
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