Provider Demographics
NPI:1356351654
Name:CARDEN, DAVID RANDALL (DMD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:RANDALL
Last Name:CARDEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3540 3RD ST S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-6062
Mailing Address - Country:US
Mailing Address - Phone:904-241-2471
Mailing Address - Fax:904-241-5673
Practice Address - Street 1:3540 3RD ST S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-6062
Practice Address - Country:US
Practice Address - Phone:904-241-2471
Practice Address - Fax:904-241-5673
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL72171223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics