Provider Demographics
NPI:1194815357
Name:ROBERT S SOUD DDS PA
Entity Type:Organization
Organization Name:ROBERT S SOUD DDS PA
Other - Org Name:THE CENTER FOR DENTAL WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:SOUD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:904-273-9999
Mailing Address - Street 1:1541 THE GREENS WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-2449
Mailing Address - Country:US
Mailing Address - Phone:904-273-9999
Mailing Address - Fax:904-273-9766
Practice Address - Street 1:1541 THE GREENS WAY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-2449
Practice Address - Country:US
Practice Address - Phone:904-273-9999
Practice Address - Fax:904-273-9766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL41711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty