MEDICARE: TOWN PARK DENTAL, P.A.

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1356800775
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOWN PARK DENTAL, P.A.

Provider Business Mailing Address
First Line	:	2801 SAINT JOHNS BLUFF RD S STE 201
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-3862
Country	:	US
Telephone Number	:	904-998-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	12950 E COLONIAL DR STE 124
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32826-4609
Country	:	US
Telephone Number	:	407-635-0704
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NICHOLAS NARDUCCI
Credential	:
Telephone Number	:	904-998-7000

Provider Enumeration Date	:	03/15/2019
Last Update Date	:	03/15/2019

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