Provider Demographics
NPI:1871647255
Name:HIDDEN HILLS FAMILY DENTISTRY
Entity Type:Organization
Organization Name:HIDDEN HILLS FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLOTH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:904-807-9127
Mailing Address - Street 1:12086 FORT CAROLINE ROAD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-2688
Mailing Address - Country:US
Mailing Address - Phone:904-807-9127
Mailing Address - Fax:904-807-9129
Practice Address - Street 1:12086 FORT CAROLINE ROAD
Practice Address - Street 2:SUITE 105
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-2688
Practice Address - Country:US
Practice Address - Phone:904-807-9127
Practice Address - Fax:904-807-9129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN13166122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty