Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jacksonville Dentistry PLLC

Organization Dental Clinic/Center · NPI 1417541079

Jacksonville Dentistry PLLC is a Dental Clinic/Center in Jacksonville, Florida. Registered with an NPI since 2021.

In the registry since
2021
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

12058 San Jose Blvd Ste 102
Jacksonville, FL 32223-8669
Phone: (904) 880-3131
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dental Clinic/Center (primary) Taxonomy 261QD0000X

Record details

NPI number1417541079
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Peter Kelly — Owner · (410) 410-3031
NPI enumeratedFebruary 24, 2021
Last updated in NPPESFebruary 24, 2021
Certification dateFebruary 24, 2021
Mailing address12058 San Jose Blvd Ste 102, Jacksonville, FL 32223-8669

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