Provider Demographics
NPI:1609959428
Name:FLORIDA FAMILY DENTISTRY P.A.
Entity Type:Organization
Organization Name:FLORIDA FAMILY DENTISTRY P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:386-447-1234
Mailing Address - Street 1:4 OLD KINGS RD N
Mailing Address - Street 2:SUITE A
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-8226
Mailing Address - Country:US
Mailing Address - Phone:386-447-1234
Mailing Address - Fax:386-447-0005
Practice Address - Street 1:4 OLD KINGS RD N
Practice Address - Street 2:SUITE A
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8226
Practice Address - Country:US
Practice Address - Phone:386-447-1234
Practice Address - Fax:386-447-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty