Healthcare Provider Details

I. General information

NPI: 1013019124
Provider Name (Legal Business Name): DESOTO COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 SE BAKER ST
ARCADIA FL
34266-8871
US

IV. Provider business mailing address

34 S BALDWIN AVE
ARCADIA FL
34266-3387
US

V. Phone/Fax

Practice location:
  • Phone: 863-993-4570
  • Fax:
Mailing address:
  • Phone: 863-993-4570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDN16641
License Number StateFL

VIII. Authorized Official

Name: DR. BONNIE MISIAK
Title or Position: DENTIST
Credential: DDS
Phone: 863-993-4570