Provider Demographics
NPI:1700594892
Name:SEABREEZE DENTAL GROUP PLLC
Entity Type:Organization
Organization Name:SEABREEZE DENTAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MELISSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-794-4424
Mailing Address - Street 1:2520 US 1 S
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-6194
Mailing Address - Country:US
Mailing Address - Phone:904-794-4424
Mailing Address - Fax:
Practice Address - Street 1:2520 US 1 S
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-6194
Practice Address - Country:US
Practice Address - Phone:904-794-4424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-08
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty