Provider Demographics
NPI:1881736064
Name:ELDRIDGE, MARION C JR (DMD)
Entity type:Individual
Prefix:
First Name:MARION
Middle Name:C
Last Name:ELDRIDGE
Suffix:JR
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 1:12078 SAN JOSE BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-1842
Mailing Address - Country:US
Mailing Address - Phone:904-260-6111
Mailing Address - Fax:904-260-6331
Practice Address - Street 1:12078 SAN JOSE BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-1842
Practice Address - Country:US
Practice Address - Phone:904-260-6111
Practice Address - Fax:904-260-6331
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN86431223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics