MEDICARE: DENTAL ARTS OF FLORIDA 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	:	1891867123
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL ARTS OF FLORIDA PA

Provider Business Mailing Address
First Line	:	7645 GATE PARKWAY
Second Line	:	SUITE 103
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256
Country	:	US
Telephone Number	:	904-998-9820
Fax Number	:	530-267-5166

Provider Business Practice Location Address
First Line	:	7645 GATE PARKWAY
Second Line	:	SUITE 103
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256
Country	:	US
Telephone Number	:	904-998-9820
Fax Number	:	530-267-5166

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANGELLA TURSUNOV
Credential	:	DMD
Telephone Number	:	904-887-1214

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	08/22/2020

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