Provider Demographics
NPI:1083969687
Name:MAPLES, NEAL AND WINTER
Entity Type:Organization
Organization Name:MAPLES, NEAL AND WINTER
Other - Org Name:ADVANCED DENTAL SERVICES OF JACKSONVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-285-8407
Mailing Address - Street 1:9109 BAYMEADOWS RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-2014
Mailing Address - Country:US
Mailing Address - Phone:904-731-0311
Mailing Address - Fax:904-731-0312
Practice Address - Street 1:9109 BAYMEADOWS RD
Practice Address - Street 2:SUITE 4
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-2014
Practice Address - Country:US
Practice Address - Phone:904-731-0311
Practice Address - Fax:904-731-0312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 182771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty