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General NPI Number Information
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NPI Number | 1962147686
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Entity Type | Organization
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Legal Business Name | JACKSONVILLE EMERGENCY DENTAL NORTH, PLLC
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Dates
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Enumeration Date | 04/28/2022
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Last Update Date | 04/28/2022
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Provider Practice Location Address
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Address Line | 1840 DUNN AVE STE 3
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City | JACKSONVILLE
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State | FL
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Zip | 32218-4785
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Country | US
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Telephone | 904-224-0046
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Fax |
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Provider Business Mailing Address
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Address Line | 789 MILL STREAM RD
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City | PONTE VEDRA BEACH
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State | FL
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Zip | 32082-4148
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Country | US
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Telephone | 904-891-6691
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Fax | 904-263-4560
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL JAMES THOMASINO
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Credential | DMD
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Telephone | 904-891-6691
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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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