Provider Demographics
NPI:1336497726
Name:FIVE POINTS DENTAL
Entity Type:Organization
Organization Name:FIVE POINTS DENTAL
Other - Org Name:ROESSLER, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:WALLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-356-4880
Mailing Address - Street 1:1529 MARGARET ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-3821
Mailing Address - Country:US
Mailing Address - Phone:904-356-4880
Mailing Address - Fax:904-356-8623
Practice Address - Street 1:1529 MARGARET ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-3821
Practice Address - Country:US
Practice Address - Phone:904-356-4880
Practice Address - Fax:904-356-8623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN149311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty