Healthcare Provider Details

I. General information

NPI: 1245798750
Provider Name (Legal Business Name): DELUCA & RESSEL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2019
Last Update Date: 03/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3429 MARINER BLVD
SPRING HILL FL
34609-2463
US

IV. Provider business mailing address

3429 MARINER BLVD
SPRING HILL FL
34609-2463
US

V. Phone/Fax

Practice location:
  • Phone: 352-666-9898
  • Fax:
Mailing address:
  • Phone: 352-666-9898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRISTIN DONO
Title or Position: OFFICE MANAGER
Credential:
Phone: 352-666-9898