BLUE WATER DENTAL OF ST. JOHNS

PONTE VEDRA, FL
NPI1821543513
Entity TypeOrganization
Authorized ContactDAVID WALLACE SORENSEN
Dentist/Owner
904-755-1966
Organization Subpart ?No
Primary Taxonomy305R00000X Preferred Provider Organization
(Licence: FL  DN20719)
Enumeration Date2016-08-23
Last Update Date2016-08-23
Business Address
BLUE WATER DENTAL OF ST. JOHNS
460 TOWN PLAZA AVE SUITE 210
PONTE VEDRA, FL 32081-5139
Phone number: 904-755-1966
Mailing Address
BLUE WATER DENTAL OF ST. JOHNS
334 WILLOW WINDS PKWY
SAINT JOHNS, FL 32259-7268
Phone number: 904-755-1966