MEDICARE: EKOS GREEN COVE SPRINGS 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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1407710387
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EKOS GREEN COVE SPRINGS PLLC

Provider Business Mailing Address
First Line	:	8794 BOYNTON BEACH BLVD STE 218
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33472-4469
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1305 N ORANGE AVE
Second Line	:
City	:	GREEN COVE SPRINGS
State	:	FL
Zip	:	32043-2547
Country	:	US
Telephone Number	:	904-282-8752
Fax Number	:

Authorized Official
Title or Position	:	TITLE MGR
Name	:	SEAN TOMALTY
Credential	:
Telephone Number	:	561-789-6611

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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