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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 Specialty Code Provider Type

Preferred Provider Organization

305R00000X
Indicates primary specialty

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

NPI Number 1821543513
LBN Legal business name BLUE WATER DENTAL OF ST. JOHNS
Authorized official DAVID SORENSEN - (DENTIST/OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 08/23/2016
Last updated 08/23/2016 - About 10 years ago
Identifiers
FL License # DN20719
FL Other 1831508084 INDIVIDUAL NPI
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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