Provider Demographics
NPI:1558901751
Name:ROLLING ACRES DENTISTRY, PA
Entity Type:Organization
Organization Name:ROLLING ACRES DENTISTRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD- DENTIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIVEK
Authorized Official - Middle Name:
Authorized Official - Last Name:NERIKAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:904-553-4859
Mailing Address - Street 1:175 NW 138TH TERRACE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JONESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32669
Mailing Address - Country:US
Mailing Address - Phone:352-332-3080
Mailing Address - Fax:352-333-3729
Practice Address - Street 1:922 ROLLING ACRES ROAD
Practice Address - Street 2:SUITE #2
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159
Practice Address - Country:US
Practice Address - Phone:352-259-8284
Practice Address - Fax:352-259-8217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty