Provider Demographics
NPI:1538592993
Name:KAYC GROUP PA
Entity type:Organization
Organization Name:KAYC GROUP PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYMBERLI
Authorized Official - Middle Name:A
Authorized Official - Last Name:MUMFORD-CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:904-493-1005
Mailing Address - Street 1:2804 SAINT JOHNS BLUFF RD S STE 200
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-3778
Mailing Address - Country:US
Mailing Address - Phone:904-493-1005
Mailing Address - Fax:904-345-2961
Practice Address - Street 1:2804 SAINT JOHNS BLUFF RD S STE 200
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-3778
Practice Address - Country:US
Practice Address - Phone:904-493-1005
Practice Address - Fax:904-345-2961
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A BETTER SMILE DENTURE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-20
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty