MEDICARE: PONTE VEDRA COMPLETE DENTISTRY, PA

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	DN0010655	FL

General Provider Information

NPI Number	:	1346260155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PONTE VEDRA COMPLETE DENTISTRY, PA

Provider Business Mailing Address
First Line	:	105 SOLANA RD STE A
Second Line	:
City	:	PONTE VEDRA
State	:	FL
Zip	:	32082-5229
Country	:	US
Telephone Number	:	904-285-7711
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 SOLANA RD STE A
Second Line	:
City	:	PONTE VEDRA
State	:	FL
Zip	:	32082-5229
Country	:	US
Telephone Number	:	904-285-7711
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ERIC L TOWNSEND
Credential	:	DDS
Telephone Number	:	904-285-7711

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	02/07/2017

Similar Medicare Providers

1306849336 — DR. ERIC L TOWNSEND DDS
Practice Location Address:

105 SOLANA RD , STE A
PONTE VEDRA, FL
32082-5229

Practice Phone: 904-285-7711
Practice Fax: 904-285-3604

1679721286 — DR. KRISTOPHER REX HARTH DMD
Practice Location Address:

105 SOLANA RD STE A
PONTE VEDRA, FL
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Practice Fax: 904-285-7895

1750256665 — RADIANT HORIZONS COUNSELING, P.L.L.C.
Practice Location Address:

430 TIMBERWALK CT UNIT 1017
PONTE VEDRA BEACH, FL
32082-6242

Practice Phone: 781-985-8353
Practice Fax:

1336146653 — DR. BONNIE K WHITE MD
Practice Location Address:

1100 SAWGRASS VILLAGE DR , SUITE 100
PONTE VEDRA BEACH, FL
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Practice Fax: 904-285-7442

1184621229 — DR. CECILIA C. OLAZAR M.D.
Practice Location Address:

130 PROFESSIONAL DR
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1013916949 — SUSAN ROST MONAHAN OD
Practice Location Address:

150 PROFESSIONAL DR STE 300
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Practice Phone: 904-285-8448
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