Provider Demographics
NPI:1093327702
Name:OAKTREE DENTAL LLC
Entity Type:Organization
Organization Name:OAKTREE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:EVENS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:904-955-1151
Mailing Address - Street 1:109 AZALEA PL
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32266-6013
Mailing Address - Country:US
Mailing Address - Phone:404-543-5366
Mailing Address - Fax:
Practice Address - Street 1:14595 PHILIPS HIGHWAY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256
Practice Address - Country:US
Practice Address - Phone:904-379-9268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental