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General NPI Number Information
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NPI Number | 1891210662
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Entity Type | Organization
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Legal Business Name | CANOPY OAK DENTAL, P.A.
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Dates
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Enumeration Date | 08/14/2017
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Last Update Date | 08/14/2017
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Provider Practice Location Address
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Address Line | 8075 SW HIGHWAY 200 STE 114-115
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City | OCALA
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State | FL
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Zip | 34481-7823
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Country | US
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Telephone | 352-237-3008
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Fax |
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Provider Business Mailing Address
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Address Line | 3545 SAINT JOHNS BLUFF RD S # 352
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City | JACKSONVILLE
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State | FL
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Zip | 32224-2682
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ACCOUNT SPECIALIST
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Name | AMBER PARKS
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Credential |
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Telephone | 904-998-7000
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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 |
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License Number State |
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