Provider Demographics
NPI:1891867123
Name:DENTAL ARTS OF FLORIDA PA
Entity type:Organization
Organization Name:DENTAL ARTS OF FLORIDA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:TURSUNOV
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:904-887-1214
Mailing Address - Street 1:7645 GATE PARKWAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256
Mailing Address - Country:US
Mailing Address - Phone:904-998-9820
Mailing Address - Fax:530-267-5166
Practice Address - Street 1:7645 GATE PARKWAY
Practice Address - Street 2:SUITE 103
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256
Practice Address - Country:US
Practice Address - Phone:904-998-9820
Practice Address - Fax:530-267-5166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty