| Seaside Children's Dentistry | |
|
1100 S Ponce De Leon Blvd Ste 2 Saint Augustine FL 32084-6013 | |
| (904) 829-6321 | |
| Not Available |
| Full Name | Seaside Children's Dentistry |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1100 S Ponce De Leon Blvd Ste 2, Saint Augustine, Florida |
| Authorized Official Name and Position | Andrew Weaver (ADMINISTRATOR) |
| Authorized Official Contact | 9043957772 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Seaside Children's Dentistry 3020 Hartley Rd Ste 210 Jacksonville FL 32257-8206 | Seaside Children's Dentistry 1100 S Ponce De Leon Blvd Ste 2 Saint Augustine FL 32084-6013 Ph: (904) 829-6321 |
| NPI Number | 1881290211 |
|---|---|
| Provider Enumeration Date | 12/10/2020 |
| Last Update Date | 03/20/2023 |
| Certification Date | 03/20/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881290211 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | () | Primary |
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