Professional Dental Alliance of St. Augustine, Pllc
NPI #1386294072 in St Augustine, Florida
Provider Information
- NPI Number
- 1386294072
- Entity Type
- Organization
- Organization Name
- Professional Dental Alliance of St. Augustine, Pllc
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Sep 16, 2019
- Last Updated
- Sep 16, 2019
Practice Location
- Address
- 2225 A1A S STE A3
- City
- St Augustine
- State
- Florida
- ZIP Code
- 32080-6374
- Phone
- (904) 201-3442
Authorized Official
- Name
- LAUREN HOWARD
- Title
- CREDENTIALING SPECIALIST
- Phone
- (757) 576-5479
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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