Healthcare Provider Details

I. General information

NPI: 1063334787
Provider Name (Legal Business Name): DESTIN DENTISTRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14081 EMERALD COAST PKWY STE A
DESTIN FL
32541-8541
US

IV. Provider business mailing address

14081 EMERALD COAST PKWY STE A
DESTIN FL
32541-8541
US

V. Phone/Fax

Practice location:
  • Phone: 850-654-6969
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: PETER KELLY
Title or Position: OWNER
Credential: DDS
Phone: 407-432-6224