| Organization Name: | SURFSIDE DENTAL CENTER, PA. |
| NPI Number: | 1740614775 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CRYSTAL L LESS (VP OF OPERATIONS) |
| Mailing Address: | 630-7 Atlantic Blvd. Neptune Beach |
| State: | FL US |
| Postal Code: | 32266 |
| Phone Number: | 9042472626 |
| Fax Number: | 9042472291 |
| NPI Enumeration Date: | 08/27/2013 |
| NPI Last Update Date: | 01/23/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 305S00000X |
| License Number: | DN15716 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | FL |
| Taxonomy Type: | Managed Care Organizations |
| Taxonomy Classification: | Point of Service |
| Taxonomy Specialization: | |
| Taxonomy Definition: | This product may also be called an open-ended HMO and offers a transition product incorporating features of both HMOs and PPOs. Beneficiaries are enrolled in an HMO but have the option to go outside the networks for an additional cost. |