Blue Water Dental Of St. Johns

LBN: Blue Water Dental Of St. Johns
Blue Water Dental Of St. Johns is an health care organization with primary practice located at 460 Town Plaza Ave Suite 210, Ponte Vedra FL 32081-5139. The organization recently has only one registered license in Managed Care Organizations / Preferred Provider Organization, which is considered as the primary health care specialty. Blue Water Dental Of St. Johns can be contacted via phone (904) 755-1966, or through Sorensen, David Wallace via phone (904) 755-1966.

Contact Information

Primary practice address
460 Town Plaza Ave Suite 210 Ponte Vedra FL 32081-5139
Phone: (904) 755-1966
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Sorensen, David Wallace Doctor of Dental Medicine (DMD)
Phone: (904) 755-1966

Health care specialties

SpecialtyCodeLicense #State
Managed Care Organizations / Preferred Provider Organization 305R00000X DN20719 Florida

Profile Details

NPI number 1821543513
LBN Legal business name Blue Water Dental Of St. Johns
DBA Doing business as
Authorized official Sorensen, David Wallace Doctor of Dental Medicine (DMD)
Entity Organization
Organization subpart 1 No
Enumeration date Aug 23rd, 2016
Last updated Aug 23rd, 2016 - about 9 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1821543513 NPPES
Florida Other 1831508084 INDIVIDUAL NPI

Popular Providers