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NPI Code Detail

MEDICARE: HIDDEN HILLS FAMILY DENTISTRY

MEDICARE: HIDDEN HILLS FAMILY 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
1122300000XDentistDN13166FL

General Provider Information

NPI Number : 1871647255
Entity Type Code : Organization
Provider Name (Legal Business Name) : HIDDEN HILLS FAMILY DENTISTRY
Provider Business Mailing Address
First Line : 12086 FORT CAROLINE ROAD
Second Line : SUITE 105
City : JACKSONVILLE
State : FL
Zip : 32225-2688
Country : US
Telephone Number : 904-807-9127
Fax Number : 904-807-9129
Provider Business Practice Location Address
First Line : 12086 FORT CAROLINE ROAD
Second Line : SUITE 105
City : JACKSONVILLE
State : FL
Zip : 32225-2688
Country : US
Telephone Number : 904-807-9127
Fax Number : 904-807-9129
Authorized Official
Title or Position : DENTIST
Name : PAUL SCHLOTH
Credential : DMD
Telephone Number : 904-807-9127
Provider Enumeration Date : 01/22/2007
Last Update Date : 08/22/2020

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Directions to “HIDDEN HILLS FAMILY DENTISTRY ” Practice Location

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