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

Jacksonville Oral Surgery PLLC

Organization Oral and Maxillofacial Surgery (Dentist) · NPI 1871123984

Jacksonville Oral Surgery PLLC is an Oral and Maxillofacial Surgery (Dentist) in Jacksonville, Florida. Works from 3 locations. Registered with an NPI since 2020.

In the registry since
2020
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

2047 Park St
Jacksonville, FL 32204-3809
Phone: (904) 388-7665
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 4232 Baymeadows Rd, Jacksonville, FL 32217-4604 — (904) 739-0690
  • 1409 Kingsley Ave Ste 5, Orange Park, FL 32073-4561 — (904) 264-7383

Specialties & licences

Oral and Maxillofacial Surgery (Dentist) (primary) Taxonomy 1223S0112X

Record details

NPI number1871123984
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Victoria Johnson — Cro · (941) 444-0558
NPI enumeratedJanuary 17, 2020
Last updated in NPPESJuly 21, 2026
Certification dateJuly 21, 2026
Mailing address2047 Park St, Jacksonville, FL 32204-3809

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