Provider Demographics
NPI:1003451816
Name:FACULTY ASSOCIATES, INC
Entity Type:Organization
Organization Name:FACULTY ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SWEITZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-273-5787
Mailing Address - Street 1:76011 WILLIAM BURGESS BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097
Mailing Address - Country:US
Mailing Address - Phone:352-273-5801
Mailing Address - Fax:352-392-3070
Practice Address - Street 1:76011 WILLIAM BURGESS BOULEVARD
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097
Practice Address - Country:US
Practice Address - Phone:352-273-5801
Practice Address - Fax:352-392-3070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN16197OtherFL DENTAL LICENSE