| St Augustine Oral & Facial Surgical Center Pa | |
|
1301 Plantation Island Dr S Suite 101 St Augustine FL 32080-3108 | |
| (904) 460-0505 | |
| (904) 460-0506 |
| Full Name | St Augustine Oral & Facial Surgical Center Pa |
|---|---|
| Speciality | Oral & Maxillofacial Surgery |
| Location | 1301 Plantation Island Dr S, St Augustine, Florida |
| Authorized Official Name and Position | Douglas L Johnson (OWNER) |
| Authorized Official Contact | 9044600505 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| St Augustine Oral & Facial Surgical Center Pa Po Box 7870 Springdale AR 72766-7870 Ph: (479) 464-5824 | St Augustine Oral & Facial Surgical Center Pa 1301 Plantation Island Dr S Suite 101 St Augustine FL 32080-3108 Ph: (904) 460-0505 |
| NPI Number | 1629288824 |
|---|---|
| Provider Enumeration Date | 05/23/2007 |
| Last Update Date | 06/23/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629288824 | NPI | - | NPPES |
| DD5857 | Other | FL | RAILROAD MEDICARE GROUP |
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