Provider Demographics
NPI:1659322014
Name:FACULTY ASSOCIATES, INC
Entity Type:Organization
Organization Name:FACULTY ASSOCIATES, INC
Other - Org Name:FACULTY ASSOCIATES PEDIATRIC CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:DEAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANA
Authorized Official - Middle Name:I
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:352-273-5800
Mailing Address - Street 1:PO BOX 100425
Mailing Address - Street 2:1600 SW ARCHER ROAD
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0425
Mailing Address - Country:US
Mailing Address - Phone:352-273-5800
Mailing Address - Fax:352-392-3070
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:D4-6
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-273-5800
Practice Address - Fax:352-392-3070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL073969302Medicaid
FL073969302Medicaid