Provider Demographics
NPI:1215370788
Name:SAN MARCO DENTISTRY
Entity Type:Organization
Organization Name:SAN MARCO DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:904-398-1247
Mailing Address - Street 1:1925 HENDRICKS AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-3305
Mailing Address - Country:US
Mailing Address - Phone:904-398-1247
Mailing Address - Fax:904-398-8647
Practice Address - Street 1:1925 HENDRICKS AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-3305
Practice Address - Country:US
Practice Address - Phone:904-398-1247
Practice Address - Fax:904-398-8647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-15
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19063122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty