Provider Demographics
NPI:1023859063
Name:OAKTREE DENTISTRY PLLC
Entity type:Organization
Organization Name:OAKTREE DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-432-6224
Mailing Address - Street 1:14595 PHILIPS HWY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-3709
Mailing Address - Country:US
Mailing Address - Phone:904-290-8766
Mailing Address - Fax:
Practice Address - Street 1:14595 PHILIPS HWY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-3709
Practice Address - Country:US
Practice Address - Phone:904-290-8766
Practice Address - Fax:904-290-8797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental