| Welltide Orthodontics LLC | |
|
420 Paseo Reyes Dr St Augustine FL 32095-8558 | |
| (904) 671-6996 | |
| (904) 671-7002 |
| Full Name | Welltide Orthodontics LLC |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 420 Paseo Reyes Dr, St Augustine, Florida |
| Authorized Official Name and Position | Susan Sara Podray (ORTHODONTIST) |
| Authorized Official Contact | 6787873863 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Welltide Orthodontics LLC 420 Paseo Reyes Dr St Augustine FL 32095-8558 Ph: (904) 671-6996 | Welltide Orthodontics LLC 420 Paseo Reyes Dr St Augustine FL 32095-8558 Ph: (904) 671-6996 |
| NPI Number | 1568370104 |
|---|---|
| Provider Enumeration Date | 09/01/2026 |
| Last Update Date | 09/01/2026 |
| Certification Date | 09/01/2026 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568370104 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | (NU) | Primary |
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