Provider Demographics
NPI:1225254220
Name:KANEHL DENTAL GROUP, P.A.
Entity Type:Organization
Organization Name:KANEHL DENTAL GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:KANEHL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:904-731-2162
Mailing Address - Street 1:7933 BAYMEADOWS WAY
Mailing Address - Street 2:SUITE 5
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7564
Mailing Address - Country:US
Mailing Address - Phone:904-731-2162
Mailing Address - Fax:904-448-1403
Practice Address - Street 1:7933 BAYMEADOWS WAY
Practice Address - Street 2:SUITE 5
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7564
Practice Address - Country:US
Practice Address - Phone:904-731-2162
Practice Address - Fax:904-448-1403
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-18
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL68541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty