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General NPI Number Information
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NPI Number | 1992687255
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Entity Type | Organization
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Legal Business Name | DIO JAX PA
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Dates
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Enumeration Date | 07/25/2025
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Last Update Date | 07/25/2025
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Provider Practice Location Address
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Address Line | 501 RIVERSIDE AVE STE 104
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City | JACKSONVILLE
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State | FL
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Zip | 32202-4935
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Country | US
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Telephone | 561-400-4179
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Fax |
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Provider Business Mailing Address
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Address Line | 6401 CONGRESS AVE STE 150
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City | BOCA RATON
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State | FL
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Zip | 33487-2862
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Country | US
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Telephone | 561-400-4179
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DANIEL NOORTHOEK
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Credential | DMD MS
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Telephone | 561-400-4179
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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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