Brandon Greenwalt Dmd Pllc
NPI #1154770733 in Jacksonville, Florida
Provider Information
- NPI Number
- 1154770733
- Entity Type
- Organization
- Organization Name
- Brandon Greenwalt Dmd Pllc
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Jun 6, 2016
- Last Updated
- Jun 6, 2016
Practice Location
- Address
- 12443 SAN JOSE BLVD STE 101
- City
- Jacksonville
- State
- Florida
- ZIP Code
- 32223-8647
- Phone
- (904) 262-6188
Authorized Official
- Name
- DR. BRANDON LEE GREENWALT, DMD
- Title
- PRESIDENT
- Phone
- (317) 408-5764
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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