Provider Demographics
NPI:1356800775
Name:TOWN PARK DENTAL, P.A.
Entity type:Organization
Organization Name:TOWN PARK DENTAL, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:NARDUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-998-7000
Mailing Address - Street 1:2801 SAINT JOHNS BLUFF RD S STE 201
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-3862
Mailing Address - Country:US
Mailing Address - Phone:904-998-7000
Mailing Address - Fax:
Practice Address - Street 1:12950 E COLONIAL DR STE 124
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-4609
Practice Address - Country:US
Practice Address - Phone:407-635-0704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental