Provider Demographics
NPI:1861814063
Name:PRIME CARE DENTAL CENTER,PA
Entity Type:Organization
Organization Name:PRIME CARE DENTAL CENTER,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY ROSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALON-ALON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:904-215-2199
Mailing Address - Street 1:1555 KINGSLEY AVENUE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-9203
Mailing Address - Country:US
Mailing Address - Phone:904-215-2199
Mailing Address - Fax:904-215-2188
Practice Address - Street 1:1555 KINGSLEY AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4560
Practice Address - Country:US
Practice Address - Phone:904-215-2199
Practice Address - Fax:904-215-2188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14708261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental