National Provider Identifier Database

BLUE WATER DENTAL OF ST JOHNS
Preferred Provider Organization

A group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level.


Contact Information

BLUE WATER DENTAL OF ST. JOHNS
460 TOWN PLAZA AVE
SUITE 210
PONTE VEDRA BEACH, FL32081-5139
Phone: 904-755-1966
Fax:
Website:
Specialty Taxonomy Code
* Preferred Provider Organization 305R00000X

* Indicates primary specialty

NPI Profile & details for BLUE WATER DENTAL OF ST. JOHNS

NPI Number 1821543513
Legal business name
LBN
BLUE WATER DENTAL OF ST. JOHNS
Authorized official DAVID SORENSEN - (DENTIST/OWNER)
Entity Organization
Organization subpart No
Enumeration date 08/23/2016
Last updated 08/23/2016 - About 10 years ago
Sole proprietor1 Not specified
Identifiers
  • FL License #: DN20719
  • FL Other: 1831508084 INDIVIDUAL NPI

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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