MEDICARE: SEABREEZE SURGICAL PLLC

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)
2	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1205550977
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEABREEZE SURGICAL PLLC

Provider Business Mailing Address
First Line	:	5117 J TURNER BUTLER BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-6080
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5117 J TURNER BUTLER BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-6080
Country	:	US
Telephone Number	:	904-467-5268
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MELISSA DENT
Credential	:
Telephone Number	:	904-537-1003

Provider Enumeration Date	:	09/27/2022
Last Update Date	:	09/27/2022

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