MEDICARE: SAN MARCO DENTISTRY

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	122300000X	Dentist	19063	FL

General Provider Information

NPI Number	:	1215370788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN MARCO DENTISTRY

Provider Business Mailing Address
First Line	:	1925 HENDRICKS AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-3305
Country	:	US
Telephone Number	:	904-398-1247
Fax Number	:	904-398-8647

Provider Business Practice Location Address
First Line	:	1925 HENDRICKS AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-3305
Country	:	US
Telephone Number	:	904-398-1247
Fax Number	:	904-398-8647

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN F HOWARD JR.
Credential	:	DDS
Telephone Number	:	904-398-1247

Provider Enumeration Date	:	04/15/2013
Last Update Date	:	08/18/2016

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Directions to “SAN MARCO DENTISTRY ” Practice Location

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