Blue Water Dental of St. Johns
NPI #1821543513 in Ponte Vedra, Florida
Provider Information
- NPI Number
- 1821543513
- Entity Type
- Organization
- Organization Name
- Blue Water Dental of St. Johns
- Primary Specialty
- Preferred Provider Organization
- Enumeration Date
- Aug 23, 2016
- Last Updated
- Aug 23, 2016
Practice Location
- Address
- 460 TOWN PLAZA AVE
- Address 2
- SUITE 210
- City
- Ponte Vedra
- State
- Florida
- ZIP Code
- 32081-5139
- Phone
- (904) 755-1966
Authorized Official
- Name
- DR. DAVID WALLACE SORENSEN, D.M.D.
- Title
- DENTIST/OWNER
- Phone
- (904) 755-1966
Specialties & Taxonomy Codes
| Specialty |
|---|
| Preferred Provider Organization |
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