MEDICARE: GERALD K. WEAVER, D.M.D. AND MICHAEL STRATTON, D.M.D., PEDIATRIC DENTI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry
2	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1083048011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GERALD K. WEAVER, D.M.D. AND MICHAEL STRATTON, D.M.D., PEDIATRIC DENTI

Provider Business Mailing Address
First Line	:	3030 HARTLEY RD STE 310
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-8213
Country	:	US
Telephone Number	:	904-264-5437
Fax Number	:	904-485-8417

Provider Business Practice Location Address
First Line	:	1584 KINGSLEY AVE STE B
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-4502
Country	:	US
Telephone Number	:	904-264-5437
Fax Number	:	904-485-8417

Authorized Official
Title or Position	:	INSURANCE MANAGER
Name	:	KAREN BAUCOM
Credential	:
Telephone Number	:	904-264-5437

Provider Enumeration Date	:	08/27/2013
Last Update Date	:	09/16/2025

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