Provider Demographics
NPI:1619328986
Name:COMMUNITY DENTAL CONSTULANTS, LLC
Entity type:Organization
Organization Name:COMMUNITY DENTAL CONSTULANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:YODER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:904-673-5869
Mailing Address - Street 1:3791 PALM VALLEY RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-4182
Mailing Address - Country:US
Mailing Address - Phone:904-673-5869
Mailing Address - Fax:904-834-2737
Practice Address - Street 1:3791 PALM VALLEY RD
Practice Address - Street 2:SUITE 204
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-4182
Practice Address - Country:US
Practice Address - Phone:904-673-5869
Practice Address - Fax:904-834-2737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19044122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty