MEDICARE: PONTE VEDRA COSMETIC 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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1396000329
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PONTE VEDRA COSMETIC DENTISTRY, PA

Provider Business Mailing Address
First Line	:	100 PROFESSIONAL DR
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-6216
Country	:	US
Telephone Number	:	904-285-8407
Fax Number	:	904-285-5346

Provider Business Practice Location Address
First Line	:	100 PROFESSIONAL DR
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-6216
Country	:	US
Telephone Number	:	904-285-8407
Fax Number	:	904-285-5346

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	MRS. KAMALA RUDOLPH
Credential	:
Telephone Number	:	904-285-8407

Provider Enumeration Date	:	07/05/2012
Last Update Date	:	07/05/2012

Similar Medicare Providers

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

130 PROFESSIONAL DR
PONTE VEDRA, FL
32082-6216

Practice Phone: 904-285-1113
Practice Fax: 904-285-3110

1154315125 — KAREN SUE WOLF OD
Practice Location Address:

150 PROFESSIONAL DR , STE 300
PONTE VEDRA BEACH, FL
32082-6216

Practice Phone: 904-285-8448
Practice Fax: 904-285-3410

1013901990 — DR. GILBERT HOUSTON OD
Practice Location Address:

150 PROFESSIONAL DR , STE 300
PONTE VEDRA BEACH, FL
32082-6216

Practice Phone: 904-285-8448
Practice Fax: 904-285-3410

1972563658 — JEFFREY DAVID COHEN P.A.-C
Practice Location Address:

55 CAMBRIDGE LN
BOYNTON BEACH, FL
33436-6216

Practice Phone: 305-458-4788
Practice Fax:

1245500487 — VISION CORE, INC.
Practice Location Address:

6216 E PACIFIC COAST HWY , #140
LONG BEACH, CA
90803-4867

Practice Phone: 866-477-3306
Practice Fax:

1902321540 — ANGELA GIUNTA
Practice Location Address:

3891 STIRLING RD
DANIA BEACH, FL
33312-6216

Practice Phone: 954-416-2444
Practice Fax:

Directions to “PONTE VEDRA COSMETIC DENTISTRY, PA ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.